PLAB 1 August 2024 > Paediatrics > Flashcards

Paediatrics Flashcards

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1
Q

Rubella symptoms?

A
  • Maculopapular rash (less intense than measles)
  • Conjunctivitis (less intense than measles)
  • Coryza (less intense than measles)
  • Forchheimer spots (red macules on soft palate and tonsils)
  • Fever
  • Lymphadenopathy
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2
Q

Rubella etiology? Risk Factors?

A

Self limiting viral disease usually caused by incomplete history of vaccination;

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3
Q

Rubella diagnosis?

A

LAB TESTING TO CONFIRM THE DIAGNOSIS
- PCR test: oral fluid sample.
- Serology: IgM antibody (positive in acute cases).

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4
Q

Rubella and pregnancy

A

► Congenital Rubella syndrome if < than 20w pregnant

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5
Q

Roseola epidemiology

A

Most common rash seen under the age of 3

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6
Q

Roseola symptoms

A
  • High fever (40C) lasts for 3 days
  • Rash after fever lasts for 3 days
  • Runny nose
    ► In most cases the child is well.
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7
Q

Roseola etiology?

A

Caused by human herpesvirus-6.

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8
Q

Roseola Rx?

A

Rx is supportive.

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9
Q

Paeds:

ASTHMA

In which situations is it recommended to intubate?

A
  • Severe resp. acidosis;
  • Silent chest (severe bronchoconstrition);
  • Altered mental status (sever hypoxia);
  • Fatigue (↓RR);
  • Failure of NIV.
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10
Q

Management of acute exacerbation of asthma in children.

A

◉ Immediate
➜ O₂:
* O₂ if SPO₂ < 94%, goal SPO₂ 94-98%;
➜ Bronchodilators
* B₂-agonist: Salbutamol nebulized or pDMI + spacer (if mild symptoms);
* Anticholinergics: ipratropium bromide;
➜ Corticosteroids:
* Prednisolone
* Hydrocortisone (if vomiting).

◉ 2nd line:
* Mg₂SO₄ IV
* Salbutamol IV
* Aminophiline IV (last resource).

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11
Q

Paeds

Symptoms of ALL (acute lymphoblastic leukaemia).

A
  • Fatigue (anaemia)
  • Bleeding, petechia, purpura, ecchymoses (trombocytopenia)
  • Recurrent infections (low or abnormal WBC’s)
  • LUQ tenderness & early satiety (splenomegaly).
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12
Q

Paeds

Diagnosis of ALL (acute lymphoblastic leukaemia)

A

► Most initial ⟶ FBC depression of all 3 cell lines:
* Anaemia (normochromic normocytic)
* WBC (low, normal or elevated)
* Thrombocytopenia

► Most appropriate ⟶ Peripheral blood test: Leukaemic blasts/lymphoblasts on peripheral blood

► Most definitive test ⟶ Bone marrow biopsy:
* Blasts cells.

Age group: 2-4 YO.

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13
Q

What are the organisms that cause acute epiglottitis?

A

➜ Unvaccinated patients: H. influenzae
➜ Vaccinated patients: Streptococcus

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14
Q

Symptoms of acute epiglottitis

A
  • Stridor
  • Drooling of saliva
  • Muffled / Hot potato voice
  • High temperature
  • Odynophagia (pain when swallowing)
  • Dysphagia
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15
Q

What is the gold standard investigation for epiglottitis?

A

Laryngoscopy.

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16
Q

What is the initial investigation in epiglottitis?

A
  • Lateral neck x-ray: thumb sign
  • Throat swabs

DO NOT USE TONGUE DEPRESSORS ➔ FATAL.

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17
Q

What is the Rx of epigottitis?

A
  • Intubation (on signs of airway obstruction)
  • IV antibiotics
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18
Q

What investigation should be done absence seizures?

A

EEG.

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19
Q

Paeds

What is the time onset of ABO incompatibility?

A
  • < 24h after birth.
  • Can be noticed on day 2-3 (as jaundice progresses).
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20
Q

Paeds

Explain the physiology of ABO incompatibility.

A
  • Mother has type O blood
  • Baby has type A, B, AB blood
  • Mother has anti-A, anti-B antibodies
  • Mother’s antibodies cross the placenta and destroy the infant’s red blood cells.

➜ Can occur in the 1st pregnancy.

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21
Q

What is the investigation in ABO incompability?

A
  • Direct antibody test (DAT) / Coombs test: weakly positive.
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22
Q

Paeds

Rx of ABO incompability

A
  • Phototherapy
  • Exchange transfusion (if severe).
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23
Q

Paeds

What is the management of umbilical hernia in children?

A

Asymptomatic:
* Reasurance
* Closes spontaneously by the 4th year.

> 4 yo asymptomatic:
* Referral to paediatric surgeon

Incarcerated / strangulated:
* Urgent referral surgery

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24
Q

What is the management of inguinal hernia in children?

A

Asymptomatic:
* Refer to 2nd care due to ↑ risk of incarceration.

Incarcerated / strangulated:
* Urgent referral surgery

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25
What are the **symptoms** of `biliary atresia`? ## Footnote **High Yield for the exam**
◆ **Jaundice** with `pale stools and dark urine`. ◆ Presents in 3-4 weeks of life. ◆ Hepatomegaly. ◆ Splenomegaly (if late presentation). ◆ Failure to thrive (due to poor absorption). ## Footnote `Obstructive jaundice` ⟶ Jaundice with pale stools and dark urine.
26
How is the **INITIAL diagnosis** of `biliary atresia` made?
◆ ⬆︎ Conjugated bilirubin (conjugated hyperbilirubinaemia); ◆ ⬆︎ **`Gamma-glutamyl transferase (GGT)`**; ◆ Abdominal ultrasound; ◆ Cholangiogram.
27
How is the **DEFINITIVE diagnosis** of `biliary atresia` made? | **High Yield for the exam**
➜ Percutaneous biopsy.
28
What is the **treatment** for `biliary atresia`? | **High Yield for the exam**
➜ Kasai procedure (hepatoportoenterostomy).
29
What is the **initial investigation** for any *child with **jaundice** **`AFTER`** `2 weeks of life`?
◉ Conjugated bilirubin.
30
What are the **symptoms** of `breast milk jaundice`?
◆ Jaundice **`IN THE 2nd week`** of life (sometimes 1st); ◆ They are usually well; ◆ `Yellow normal stools`; ◆ May resolve within 6 weeks or continue up to 4 month.
31
How is the **investigation / diagnosis** of `breast milk jaundice` made?
◆ Perform split bilirubin test ➜ Will show **` ⬆︎ unconjugated bilirubin`**.
32
What is the **management** of `breast milk jaundice`?
◆ Continue to breastfeed. ◆ Reassurance.
33
What are the **symptoms** of `bronchiolitis`?
◆ Cough / coryza ◆ `Expiratory wheeze` ◆ Respiratory distress ◆ Bilateral crepitations/crackles ◆ ⬆︎ RR ◆ Chest rectractions ◆ Mild fever
34
What is the **age group** of `bronchiolitis`?
< 2 YO.
35
What is the **cause** of `bronchiolitis`?
➜ Acute viral infection of the lower respiractory tract, caused by **`respiratory syncytial virus`**.
36
What is the **treatment** of `bronchiolitis`?
◉ **Supportive treatment:** ◆ O₂ (humidified) ◆ Nasogastric tube (feeding)
37
Define **Croup**.
Also known as **laryngotracheobronchitis**. It's an UTRI that affects the: ◆ Larynx ◆ Trachea ◆ Bronchi
38
What are the **symptoms** of `croup`? | **Laryngotracheobronchitis**
◆ Barking cough ◆ `Inspiratory stridor` ◆ Mild fever ◆ Hoarse voice
39
What is the **treatment** for `croup`?
► **Mild cases:** ◆ Oral dexamethasone ► **Moderate cases:** ◆ O₂ ◆ Nebulised budesonide ► **Severe cases:** ◆ O₂ ◆ Nebulised adrenaline ◆ Intubation if required ## Footnote **`NO IV STEROIDS in croup.`**
40
What is the **cause** of `croup`?
Parainfluenza.
41
Describe what is **cerebral palsy** and its epidemiology.
► Chronic disorder of movement and/or posture, that presents early in life and continues throrought life. ➜ Caused by a non-progressive brain injury
42
Management of **cerebral palsy**?
Multidisciplinary team involved.
43
*Treatment* for **`hypertonia`** in **cerebral palsy**?
◆ Botulinum toxin injections ◆ Baclofen
44
What are the **symptoms** of **`coeliac disease`**?
◉ *`Autoimmune disease due to gluten sensintivity which results in malapsorption.`* ◆ Diarrhoea (chronic or intermittent) ◆ Stinking stools ◆ Steatorrhea ◆ Bloating, nausea and vomiting ◆ Fatigue ◆ Weight loss ◆ Iron deficiency anaemia
45
What are the **complications** of `coeliac disease`?
◆ Osteoporosis ◆ T cell lymphoma of the small intestine
46
What `investigations` are done in **coeliac disease**?
`These tests must be done with gluten re-introduced in the patients diet for a minimum of 6 weeks!` **1. Specific auto-antibodies** ◆ Tissue tranglutaminase (TTG) antibodies (IgA) ◆ Endomysial antibody (IgA) **2. Jejunal/Duodenal biopsy**
47
Management of `coeliac disease`?
Gluten free diet.
48
Describe the **symptoms** of `breath holding spells`.
◉ `Symptoms` ◆ Happens after a child that was crying vigourously ◆ **Turns blue and then stops breathing** ◉ `Cause:` ◆ Stress, anger, anxiety ◆ Loss of counsciousness <1min
48
Describe the **symptoms** of `reflex anoxic seizures`.
◉ `Symptoms` ◆ Sudden fright or pain (may or may not cry) ◆ **Stops breathing and then turns pale** ◉ `Cause:` ◆ Stress, anger, anxiety ◆ Loss of counsciousness <1min
49
**Management** of *breath holding spells* and *reflex anoxic seizures*?
◆ Reassurance ◆ Advise parents to put child on recovery position ◆ Check ferritin and treat iron deficiency if present.
50
What is the `cause` of **congenital adrenal hyperplasia**?
Autossomal recessive disorder caused by: ➜ `21-hydroxylase deficiency.`
51
**Symptoms** of `congenital adrenal hyperplasia`.
► **General:** ◆ Hyponatraemia ◆ Hyperkalaemia ◆ Vomiting ► **Females:** ◆ Ambiguous genitalia with enlarged clitoris ► **Males:** ◆ Hyperpigmentation ◆ Penile enlargement
52
**Treatment** of congenital adrenal hyperplasia
◆ `Glucorticoids` (prednisolone, hydrocortisone) ◆ `Mineralocorticoids` (fludrocortisone) ◆ `Surgery` (for ambiguous genitalia)
53
Describe the **non classical symptoms** of `congenital adrenal hyperplasia`.
◆ Caused by **overproduction of 17-hydroxyprogesterone** ◆ Presents in late childhood or early adulthood with `hirsutism`, `acne` and `oligomenorrhoea`
54
What is the `management` of **congenital cytomegalovirus**?
➜ **PCR:** oral swabs of the neonate; ➜ **Ganciclovir:** given to the neonate to slow down disease progression.
55
What are the `complications` of **congenital cytomegalovirus**?
◆ **`Sensorineural hearing loss`** ⟶ *most common* ◆ Cataracts ◆ Microcephaly ◆ Low birth weight ◆ Learning disability
56
What is the most likely outcome of **congenital cytomegalovirus**?
Normal development.
57
What are the **symptoms** of `congenital hypothyroidism`?
◆ Prolonged jaundice ◆ Difficulty feeding ◆ Lethargy ◆ Goitre
58
What are the **physical signs** of `congenital hypothyroidism`?
◆ Macroglossia ◆ Large fontanelles ◆ Jaundice ◆ Umbilical hernia ◆ Hoarse voice
59
How is the **diagnosis** of `congenital hypothyroidism` done?
◉ **Heel prick test** (when the newborn is 5 days old) ◆ ⬆︎TSH ◆ ⬇︎ T4 ◉ **If heel prick test positive:** ◆ Radioisotope scan ◆ Ultrasound of the neck
60
**Treatment** of `congenital hypothyroidism`?
➜ Oral levothyroxine until 2yo.
61
What is the **management** of *constitutional delay in growth and puberty?*
**X-ray of the left wrist:** ◆ Significant short stature / growth delay. **Review in 6 months** (no x-ray): ◆ Strong family history of late bloomers. ◆ Minor variations of growth rate. ◆ Healthy child.
62
**Describe** the `adrenal axis physiology`. | Cushings syndrome
1. *Hypothalamus* releases **CRH hormone** 2. *CRH* acts on the **anterior pituitary gland** 3. *Anterior pituitary* releases `ACTH hormone` 4. *ACTH* acts on the `adrenal gland` 5. *Adrenal gland* releases **`cortisol`** 6. *Cortisol* does the following: ◆ Inhibits the immune system; ◆ Inhibits bone formation; ◆ ⬆︎ blood glucose ◆ ⬆︎ metabolism ◆ ⬆︎ alertness 7. ⬆︎ Cortisol sends a negative feedback to the anterior pituitary and to the hypothalamus, and they ⬇︎ the production of their hormones.
63
What is **Cushings syndrome**?
Condition caused by **prolongued exposure** of `endogenous or exogenous glucorticoids` leading to excessive cortisol on the body.
64
What are the `causes` of **Cushings syndrome**?
◉ **`ACTH dependent disease`** ◆ ***Cushings disease***: Pituitary adenoma; ◆ ***Ectopic ACTH***: small lung carcinoma ◉ **`Non-ACTH dependent`** ◆ Adrenal adenoma/carcinoma ◆ Exogenous steroids
65
What are the `symptoms` of **Cushings syndrome**?
◆ Round face ◆ Buffalo hump ◆ Abdominal obesity ◆ Purple abdominal striae ◆ Muscle weakness ◆ Osteoporosis ◆ Depression and insomnia
65
How is the `diagnosis` of **Cushings syndrome** done?
**1.** 24h urinary free cortisol **2.** Dexamethasone suppression test (low dose)
66
Explain how the **`low` dose dexa supression test** is done and its `clinical relevance`.
**1.** 1mg of Dexa is giving at midnight. **2.** Cortisol (plasma) is measured the next day at 9 am. ➜ **If positive for Cushings:** ◆ 1mg of dexa `won't be enough` to supress the hypothalamus (CRH) or the anterior pituitary (ACTH), as the body is used to ⬆︎ levels of cortisol. ➜ **If negative for Cushings:** ◆ Cortisol < 50 nmol/L. ◆ 1mg of dexa `will be enough` to supress the hypothalamus and the anterior pituitary.
67
After `positive dexa supression test` (low dose), what is the next step? | Cushings syndrome
◉ Differentiate the causes of Cushings by doing: ➜ **High dose dexamethasone supression test.**
68
Explain how the **`high` dose dexa supression test** is done and its `clinical relevance`.
`◘ 8mg of dexa is administered.` ➔ **Cushing disease/pituitary adenoma:** ◆ ACTH ⬇︎ ◆ Cortisol ⬇︎ ◆ 8 mg would supress the ACTH/adenoma ➔ **Adrenal adenoma:** ◆ ACTH ⬇︎ ◆ Cortisol ⬆︎ ◆ 8 mg would supress the pituitary but the source of the ↑ cortisol is on the kidney itself. ➔ **Ectopic ACTH (lung carcinoma):** ◆ ACTH ⬆︎ ◆ Cortisol ⬆︎ ◆ The source of the ↑ cortisol is elsewhere even though the pituitary is supressed.
69
What is the **cause** of `cystic fibrosis`?
Autosomal recessive disease caused by: ➜ `Defect in CFTR gene.`
70
What are the **symptoms** of `cystic fibrosis`?
*Symptoms usually start on early childhood, and progressively gets worse overtime.* ➜ Excretion of Na⁺ and Cl⁻ into the airways which ↑ mucus viscosity. ➜ **Thick mucus clogs the lungs and pancreas.** ◆ Recurrent lung infections ◆ Cough ◆ SOB ◆ Malabsorption (steatorrhoea/failure to thrive) ◆ Salty skin/sweat ◆ Meconium ileus (newborn) ◆ Delayed sexual development
71
What **microrganisms** `cause recurrent lung infection` in *cycstic fibrosis*.
◆ **Children:** S. aureus ◆ **Adults:** Pseudomonas aeruginosa ◆ Haemophilus influenzae
72
# . Diagnosis of cystic fibrosis
◉ **Newborns:** ◆ Heel prick test ➝ If positive ◆ Genetic testing for CFTR gene ◆ Sweat test ◉ **Older children** (not diagnosed when born): ◆ Sweat test ◆ Genetic testing for CFTR gene ◆ Chest X-ray
73
Rx of cystic fibrosis
◆ Pancreatic enzyme replacement ◆ Dornase alfa and hypertonic saline to reduce mucus viscosity ◆ Chest physioterapy ◆ Bronchodilators ◆ Nebulised tobramycin / colistimethate for chronic P. aeruginosa ◆ Lung transplantation if resp. failure.
74
What is the cause of Erb's palsy?
Injury of the upper brachial plexus at the level of: ◆ C5-C7 It happens during childbirth.
75
Describe febrile seizures.
◆ Seizures accompanied by fever **`without`** signs of **CNS infection** or **electrolyte abnormalities**. ◆ Most common between 6 mths - 6 YO.
76
Classification of febrile seizures
**Simple** ◆ `< 15 min` + generalised tonic clonic. **Complex** ◆ `> 15 min` OR focal. ◆ Recurrent. **Febrile status epilepticus** ◆ > 30 min without complete recovery.
77
Management of febrile seizures
◆ Place the patient in recovery position ◆ ABCDE ◆ If `seizure > 5min` than **BZD** (buccal midazolan or rectal diazepam) ◆ Search for other cause of seizures (hypoglycaemia, electrolyte imbalances, meningitis).
78
When to give `paracetamol` in **febrile seizures**?
Seizures + Fever + Pain/Distress
79
What are the **symptoms** of `galactosaemia`?
◆ Prolonged jaundice ◆ Yellow stools ◆ Pale urine ◆ Failure to thrive ◆ Vomiting ◆ Hepatomegaly
80
What is the **treatment** of `galactosaemia`?
Discontinue milk to remove the lactose load and prevent progression to liver disease.
81
Symptoms of GORD | Gastro-oesophageal reflux disease
◆ Recurrent regurgitation ◆ Gagging or choking during feeds ◆ Cries after feeds ◆ Refuses feeds ◆ Aspiration pneumonia | Age group <1 yo.
82
Risk factors for GORD?
◆ Premature birth. ◆ Obesity.
83
Rx of GORD
◆ Smaller and frequent meals ◆ Trial of thickened formula ◆ Alginate therapy (gaviscon) ◆ PPI (proton pump inhibitors) & H2 blockers
84
Describe the `triad` of **haemolytic uraemic syndrome** (HUS)
◆ Haemolytic anaemia ◆ Thrombocytopenia ◆ Acute renal failure
85
Describe the `peripheral blood smear` of **HUS**
*Presence of:* ◆ Schistocytes ◆ Helmet cells ◆ Fragmented red cells
86
What is the `cause` of **HUS**?
Occurs after an episode of `bloddy diarrhea` caused by: ◆ **E. coli**
87
Rx of HUS
➜ **`DO NOT give antibiotics`** *(E.coli releases toxins upon dying which will worsen the disease)* ◆ Fluids (transfusion if needed) ◆ Antihypertensive meds ◆ Dialysis ## Footnote ****
88
What is the `cause` of **hand, foot and mouth disease**?
➜ It is a self limiting viral disease caused by: ◆ **Coxsackievirus**
89
`Symptoms` of hand, foot and mouth disease?
◆ Fever ◆ Sore throat ◆ Oral ulcers ◆ Vesicles on the palms and soles of the feet ◆ Macules on the palms and soles of the feet
90
Describe *what is* `Henoch-Schonlein purpura` and its *epidemiology*.
◆ It's a small vessel systemic vasculitis ◆ Affects children 2 - 11YO.
91
Symptoms of `Henoch-Schonlein purpura`.
◆ Purpura (buttocks & legs) ◆ Joint pain ◆ Abdominal pain ◆ Bloody diarrhoea ◆ Glomerulonephritis (proteinuria & hematuria) ◆ Recent h/o URTI or gastroenteritis ◉ **Peter `PAAN`** ➔ **`P`**urpura *(PLT in the normal range)* ➔ **`A`**bdominal pain ➔ **`A`**rthralgia ➔ **`N`**ephropathy
92
Management of `Henoch-Schonlein purpura`.
➜ Conservative management ◆ Arthralgia ⟶ NSAIDS
93
What are the `symptoms` of **idiopathic trombocytopenic purpura**?
◆ Trombocytopenia ◆ Epistaxis/Menorrhagia/GI bleed ➔ Onset after 1-2 weeks of URTI ➔ Age: 2-10YO
94
Management of **idiopathic trombocytopenic purpura**?
**First line:** ◆ Prednisolone **Second line:** ➔ If bleeding & unresponsive to corticosteroids ◆ IV immunoglobulin **Third line:** ➔ `Only in life threatening bleeding` ◆ Platelet transfusion ## Footnote **Life threatning bleed:** * Intracranial bleeding * High volume bleeding * Hypotension * Etc.
95
# Paeds What are the **symptoms** of `UTI`?
◆ Fever ◆ Abdominal pain ◆ Loin pain ◆ Dysuria ◆ Increased frequency
96
# Paeds Risk factors for UTI?
◆ Stasis of urine (renal calculi, VUR, phimosis); ◆ Constipation ◆ Sexual abuse ◆ Previous hx of UTI
97
What are the **investigations** done in `UTI`?
➔ **Urine culture & sensitivity:** ◆ Clean catch urine sample ◆ Catheter sample ◆ Suprapubic aspiration ➔ **Dipstick testing:** ◆ Searching for nitrites
98
# Paeds Rx for UTI?
◆ Nitrofurantoin MR 100 mg BD (2x/day) ◆ Trimethoprim 200 mg BD
99
Describe the **imaging** for `UTI` in patients **`< 6mths`**.
◉ **If responds to Rx in < 48h:** ◆ USS within 6 weeks ◆ MCUG if USS is abnormal ◉ **Atypical UTI:** ◆ Immediate USS (during infection) ◆ Perform DMSA scan 4-6 mths after infection ◆ `Perform` MCGU ◉ **Recurrent UTI:** ◆ Immediate USS (during infection) ◆ Perform DMSA scan 4-6 mths after infection ◆ `Perform` MCGU ## Footnote MCUG: micturating cystourethrography
100
Describe the **imaging** for `UTI` in patients between **`6mths - 3 YO`**.
◉ **If responds to Rx in < 48h:** ◆ No imaging required ◉ **Atypical UTI:** ◆ Immediate USS (during infection) ◆ Perform DMSA scan 4-6 mths after infection ◆ `Consider` MCGU ◉ **Recurrent UTI:** ◆ USS within 6 weeks ◆ Perform DMSA scan 4-6 mths after infection ◆ `Consider` MCGU
101
**On children > 6 mths** when can `MCGU` be performed?
◆ Dilation of ureter on USS ◆ Poor urine flow ◆ Family h/o of VUR ◆ Non E.coli infection
102
Describe the **imaging** for `UTI` in patients **`> 3 YO`**.
◉ **If responds to Rx in < 48h:** ◆ No imaging required ◉ **Atypical UTI:** ◆ Immediate USS (during infection) ◉ **Recurrent UTI:** ◆ USS within 6 weeks ◆ Perform DMSA scan 4-6 mths after infection.
103
Describe **infantile spasms**.
◉ Type of a seizure that begins around `6mths of age` and is a **part of West Syndrome**: ◆ Mental retardation ◆ EEG abnormalities ◆ Infantile spasms
104
**Cause** of infantile spasms?
◆ Any condition that results in brain injury (inclunding Down syndrome) ◆ Idiophatic
105
**Presentation** of infantile spasms?
Contractions commonly occur just before sleeping or upon waking up.
106
What is the **investigation** done in `infantile spasms`?
➔ **EEG**: ◆ Hypsarrhythmia
107
What is the **RX** in `infantile spasms`?
◆ ACTH depot (hormone?) ◆ Prednisolone ◆ Vigabatrin *(`drug of choice in tuberous sclerosis)`* ## Footnote ACTH ⬇︎ neuronal excitability by inducing steroids release.
108
What is the **cause** of `infant respiratory distress syndrome`?
◆ `Inadequate surfactant production` in the alveoli **⟶** widespread alveolar collapse. ► *Surfactant production begins at 24 weeks gestation but `adequate amounts to prevent atelectasis begins at` **`32 weeks`**.*
109
Risk factors for `infant respiratory distress syndrome`?
◆ Premature birth ◆ C-section delivery ◆ Maternal diabetes ◆ Meconium aspiration syndrome
110
What are the **symptoms** of `infant respiratory distress syndrome`?
◆ ⬆︎ RR ◆ Subcostal and intercostal rectrations ◆ Expiratory grunting ◆ Cyanosis if severe
111
What are the **investigations** for `infant respiratory distress syndrome`?
◆ SPO₂ ◆ Blood gases ◆ **Chest x-ray:** ground glass (atelectasis) / fine granular opacities
112
What is the **Prevention** and **Rx** for `infant respiratory distress syndrome`?
◉ **Prevention:** ◆ Steroids administered to mother IM antenatally ◉ **Rx:** ◆ Surfactant administered down the ETT ◆ IPPV ◆ Fluid and electrolyte monitoring
113
# Paeds Describe the **characteristics** of `innocent murmurs`.
◆ Heard at the lower left sternal edge ◆ Louder (when the child is) in suppine position ◆ Changes with position and respiration
114
Describe the **management** of `innocent murmurs`.
Reassurance.
115
# Paeds Describe what is **intussusception** of the intestines.
◆ Invagination / telescope of the intestines ⟶ bowel obstruction. | 5 mths - 3 YO.
116
What are the `symptoms` of **intussusception**?
◆ Abdominal pain (knees drawn to chest) ◆ Abdominal distention ◆ Bilious vomiting ◆ **Red-currant jelly stool** ◆ `Palpable sausage shape mass` in the abdomen
117
What are the `investigations` done in **intussusception**?
➔ **USS - `gold standard`**: ◆ Doughnut shape / target sign. ➔ **Barium enema**: ◆ Invasive so not the best option
118
What is the `Rx` done in **intussusception**?
◆ Electrolyte and fluids correction ◆ Air enema reduction (if no perforation / peritonitis) ◆ Laparatomy
119
What are the **symptoms** of `Kawasaki` disease?
► *It is a systemic vasculitis most commonly seen < 5 YO.* ◆ Fever *(>39º C for > 5 days)* ◆ Conjuctivitis (non exudative) ◆ Strawberry tongue ◆ Cervical lymphadenopathy (painless) ◆ Rash (non vesicular) ◆ Extremities: *erythema of the palms and soles*  that progresses to peeling;
120
What is the **severe complication** of `Kawasaki` disease?
Coronary artery aneurysm. ## Footnote Develops if the disease is left untreated.
121
What is the **Rx** of `Kawasaki` disease?
◉ **IV immunoglobulins:** ◆ Prevents coronary arteries aneurysm (if given in the first 10 days). ◉ **Aspirin (`high dose`):** ◆ Prevents thromboembolism ◉ **AAS (`low dose`):** ◆ After fever is controlled ◆ After inflammatory markers have ⬇︎ ◆ Given until 6 weeks while awaiting USS (to exclude aneurysm)
122
What is the **investigation** done in `Kawasaki` disease?
◆ Ultrasound *(after 6 weeks of treatment with aspirin)*. ◆ To exclude aneurysm.
123
What are the `symptoms` of **malrotation and volvulus**?
**Sudden onset** of symptoms in `neonates` characterised as: ◆ Vomiting (green, bilious) ◆ Rectal bleeding
124
What are the `investigations` done in **malrotation and volvulus**?
➔ **Abdominal x-ray:** ◆ Double bubble sign ➔ **Barium enema**
125
What is the `Rx` of **malrotation and volvulus**?
◆ ABCDE ◆ Nasogastric tube for decompression **`◆ URGENT laparatomy`**
126
What is **Marfan syndrome**?
◆ Autossomal dominat condition ◆ Caused by mutation in fibrillin gene
127
Symptoms of Marfan syndrome?
◉ **General:** ◆ Tall & thin ◆ Long: arms, finger, legs and toes ◆ Flexible joints ◆ Scoliosis ◉ **Cardiovascular:** ◆ Mitral valve prolapse ◆ Mitral regurgitation ◆ Aortic regurgitation ◆ Aortic dissection & aneurysm ◉ **Pulmonary:** ◆ Recurrent pneumothorax ◉ **Eyes:** ◆ Lens dislocation ◆ High myopia
128
What are the **symptoms** of `Measles`?
◆ `Koplic spots` *(white spots on oral mucosa BEFORE RASH)* ◆ Itchy `maculopapular rash` that starts behind the ear (Head ➜ Body); ◆ Cough, coryza ◆ Conjuctivitis ◆ Fever
129
Rx for measles?
**Supportive Rx:** ◆ Paracetamol ◆ Fluids ◆ Calamine lotion (for rash) | Avoid contact with young children and pregnant woman.
130
Describe the **characteristics** of `Meckel's diverticulum`?
◆ Age 2-3 YO ◆ 2 feet away from ileo-caecal valve
131
Describe the **symptoms** of `Meckel's diverticulum`?
◆ Most patients are asymptomatic `◆ Painless rectal bleeding` ◆ **If obstruction:** vomiting and abdominal pain.
132
What is the **cause** of `meconium aspiration syndrome`?
◆ Aspiration of meconium before or at the time of delivery. ◆ Meconium will inhibit surfactant and obstruct the respiratory tract.
133
What are the `risk factors` for **meconium aspirated syndrome**?
◆ Post term date (>42 weeks) ◆ Maternal hypertension ◆ Oligohydramnious ◆ Placental insufficiency
134
Rx of **meconium aspirated syndrome**?
◆ Suction of airways ◆ O₂ ◆ Fluid and electrolyte ◆ Antibiotics (when needed)
135
Cause of nephrotic syndrome?
◆ Minimal change disease
136
What are **symptoms** of `nephrotic syndrome`?
◆ Proteinuria (> 3.5g/24h) ◆ Hypoalbuminaemia (< 30g/L) ◆ Oedema
137
Rx of nephrotic syndrome?
**First line:** ◆ Steroids **Second line:** ◆ Cyclophosphamide
138
# Paeds What are the **symptoms** of `necrotising enterecolitis`?
◆ Abdominal x-ray: *air in the bowel wall* ◆ Bloody stools ◆ Vomiting ◆ Doesnt's tolerate feeding ◆ Abdominal distension
139
What are the **investigations** in `necrotising enterecolitis`?
**Most initial:** ◆ X-ray **Others:** ◆ Cultures ◆ Blood films ◆ Coagulation studies
140
What is the **Rx** in `necrotising enterecolitis`?
**Initial:** ◆ Stop feedings **Others:** ◆ NG tube (free drainage & aspiration) ◆ Fluids + electrolytes ◆ Antibiotics ◆ Surgery (if pneumoperitoneum)
141
What is the `MOA` of **physiological / neonatal jaundice**?
◆ ⬆︎ RBC breakdown ◆ Immature liver to process bilirubin
142
Rx of physiological jaundice?
**Phototherapy** ◆ If bilirubin is midly above the cut-off point for age. **Exchange transfusion** ◆ If bilirubin is highly elevated above the cut-off point for age
143
What are the `pathological causes` of **physiological / neonatal jaundice**?
◆ Rhesus incompability ◆ ABO incompability ◆ G6PD ◆ Sepsis
144
What is the `time onset` of **physiological jaundice**?
24h to 2weeks after birth.
145
What is the `step by step management` of *`jaundice`* `after 2 weeks of life`?
◉ **First step:** ◆ Bilirubin investigation ➔ **If ⬆︎unconjugated bilirubin:** ◆ Breast milk jaundice ◆ Reasurrance ➔ **If ⬆︎conjugated bilirubin:** ◆ Biliary atresia ◆ Surgery: Kasai procedure
146
What are the **risk factors** for `neonatal sepsis`?
◆ Premature rupture of membranes ◆ Chorioamnionitis ◆ Prematurity
147
What is the investigation in neonatal sepsis?
◆ Blood culture
148
NICE🚦light system
Admit patients if < 5YO presenting with any of the following features. **`RED features:`** **Infectious:** ◆ Fever > 38C (0-3 months) **Skin:** ◆ Blue ◆ Pale ◆ Non-blanching rash **Respiratory:** ◆ Grunting ◆ RR > 60 cpm ◆ Moderate chest indrawing **Hydration:** ◆ Reduced skin turgor **Neuro:** ◆ Focal seizures ◆ Neck stiffness
149
What are the **features** of `non-accidental injury`?
◆ Delayed time to medical presentation ◆ Step-father/boyfriend accompanies the child ◆ Bruises of varying degrees and colours ◆ Bruises at unusual sites ◆ Fractures: rib & spiral
150
Rx of non accidental injury:
◆ Admit ◆ Pain management ◆ Call safeguarding team ◆ Referral to social services ◆ Management of other conditions
151
# Paeds What is the **cause** of `OSA`?
Enlarged: ◆ Tonsils ◆ Adenoids
152
# Paeds Symptoms of OSA?
◆ Snoring ◆ Mouth breathing ◆ Witnessed apnoeic episodes ◆ Nasal speech
153
What is the **GOLD standard** *`investigation`* of `OSA`?
Polysomnography. | Sleep study.
154
Rx of OSA?
◆ Surgery ◆ Referral to ENT.
155
What is the **organism** associated with `osteomyelitis`? | Bone infection
◆ S. aureus.
156
**Difference** between `Otitis media` and `Otitis externa`?
Otitis externa: ◆ Pain and discharge `simultaneously` Otits media: ◆ Pain `before` discharge
157
What is the **most common** **cause** of `conductive hearing loss` in **childhood**?
◆ Otitis media with effusion (ear glue) ◆ Often painless
158
# **Management of:** Primary bedwetting: overactive bladder **`WITH`** DAYTIME symptoms. | DAYTIME SYMPTOMS
◆ If > 2YO: Referal to secondary care / enuresis clinic **First line:** ◆ Bladder retraining / behavioral therapy **Second line:** ◆ Oxybutin **Others:** ◆ Desmopressin (oral or sublingual ONLY)
159
**Management** of primary bedwetting **`WITHOUT`** DAYTIME symptoms
◉ < 5 YO ◆ Reassurance ◉ > 5 YO ➔ < 2x/week: Reassurance + Positive reward system ➔ ≥ 2x/week short term control: desmopressin ➔ ≥ 2x/week long term control: Enuresis alarm + Positive reward system
160
Describe the `developmental milestones`. - 3 months - 6 months - 9 months - 12 months
**3 months:** ◆ Holds neck **6 months:** ◆ Body rolls on both directions **9 months:** ◆ Crawling **12 months:** ◆ Walk
161
# Paeds drawings Describe the `fine motor skill milestones`. - 2 years - 3 years - 4 years - 5 years - 6 years
**2 years:** ◆ Draws a line **3 years:** ◆ Draws a cirlce **4 years:** ◆ Draws a cross and a square **5 years:** ◆ Draws a triangle **6 years** ◆ Draws a diamond
162
# Paeds When to refer to `specialist community paediatric assesment`? - 5 months - 6 months - 12 months - 18 months - 2 years - 2.5 years | If delayed milestones
**5 months:** ◆ Unable to hold object placed in hand **6 months:** ◆ Unable to reach for objects **12 months:** ◆ Unable to sit unsupported **18 months:** ◆ No speech ◆ If no monosylabic words at 15 months ⟶ hearing test **2 years:** ◆ Unable to put 2 words together in a phrase (push car). **2.5 years** ◆ Unable to run
163
What are the **types** of `paeds fluids therapies`?
1. Ressuscitation 2. Maintenance 3. Replacement
164
# **Fluids therapy** Resuscitation IV fluids
➔ **Indicated in shock** ◆ `10ml/Kg IV in < 10 min` ◆ In moderate to severe dehydration
165
# **Fluids therapy** Maintenance IV fluids
➔ **Indicated if oral intake insufficient to maintain hydration.** ➔ **Indicated in the perioperative period when patint is nill by mouth.** ► Holliday-Segar formula ◆ Child > 28 days old. ◆ First 10 Kg ⟶ 100 ml/Kg/day ◆ Next 10 Kg ⟶ 50 ml/Kg/day ◆ Reimaning ⟶20 ml/Kg/day ➔ **`Rate calculation`** ◆ Divide the total by 24 ◆ Administer in 48h in hypernatreamia
166
What is the **cause** of slapped cheek syndrome / erythema infectiosum?
Parvovirus B19
167
**Symptoms** of slapped cheek syndrome / erythema infectiosum?
◆ Fever ◆ Coryza ◆ Erythematous maculopapular rash on the cheeks
168
**Management** of slapped cheek syndrome / erythema infectiosum?
◆ Supportive ➔ Once rash develops no need to stop school
169
What is the `management` of **Vitamin D supplementation**?
**0 - 1 years:** ◆ 340 - 400 UI daily **> 1 year:** ◆ 400 UI daily
170
What is the `cause` of **pertussis**? | Whooping cough
◆ Bordetella pertussis ◆ Lack of vaccinations
171
`Symptoms` of of **pertussis**?
◆ Bout of cough ◆ Vomiting after coughing ◆ Inspiratory whoop ◆ Apnoea or cyanosis
172
Investigations for pertussis? | Whooping cough
**Young children and infants:** ◆ Pernasal swab for PCR **Older children & adults:** ◆ Nasopharygeal swabs for PCR **If > 2 weeks of coughing:** ◆ Serology
173
Rx for pertussis | Whooping cough
Macrolides: azithromycin, clarithromicyn
174
What are the **symptoms** of `pyloric stenosis`?
◆ Olive shape mass in the abdomen ◆ Projectile non-bilious vomiting after feeding ◆ Constant hunger ◆ Weight loss ◆ Dehydration ◆ Electrolyte abnormalities ◆ Metabolic alkalosis
175
**Investigations** done in `pyloric stenosis`
**Most initial:** ◆ Serum K⁺ **Most definitive:** ◆ USS
176
Rx in pyloric stenosis
First line: ◆ Correction of fluids and electrolytes imbalance Most definitive Rx: ◆ Surgery
176
Cause of scarlet fever?
◆ Streptococcus pyogenes
177
Symptoms of scarlet fever
◆ Fever (> 38ºC) ◆ Sore throat ◆ Strawberry tongue ◆ Cervical lymphadenopathy ◆ *Rash*: - Torso ⟶ extremities - Sandpaper texture
178
Rx of scarlet fever
**1st line:** ◆ Penicilin for 10 days **2nd line:** ◆ Azithromycin for 10 days
179
Advice to give to parents regarding ⬇︎ risk in **sudden infant death syndrome**?
◆ Avoid smoking near infants ◆ Infants should sleep on their back (not front or sides) ◆ Feet of infant at the foot of the cot ◆ Avoid pillows ◆ Avoid overheating by heavily wrapping ◆ Use sheets or blankets, avoid duvets ◆ Blankets should not be higher than shoulders ◆ Avoid taking infant into bed with parents after alcohol or sedatives consumption ◆ Avoid sleeping with infant on sofa
180
What are the **symptoms** of `Tourette's syndrome`?
◆ Obscene verbal ejaculation ◆ Tics
181
**Rx** of `Tourette's syndrome`?
◆ Behavioural therapy ◆ Risperidone and haloperidol if necessary
182
`Cause` of **transient tachypnoea of the newborn**
◆ Delay of reabsortion of lung liquid
183
Symptoms of **transient tachypnoea of the newborn**
Respiratory distress
184
`Investigations` of **transient tachypnoea of the newborn**
◆ X-ray: Fluid in the horizontal fissure.
185
`Management` of **transient tachypnoea of the newborn**
◆ O₂
186
What is the **vesicoureteric reflux**?
➔ The retrograde flow of urine from bladder ➝ ureters ➝ kidneys.
187
Symptom of vesicoureteric reflux?
◆ Usuallly asymptomatic ◆ May present as UTI
188
Investigation of vesicoureteric reflux?
**Initial:** ◆ Urinalysis, urine culture + sensitivity ◆ Renal uss **Goldstandard:** ◆ Micturating cystourethrogram **Parenchymal damage dtected:** ◆ DMSA
189
RX of vesicoureteric reflux
**Grade I-IV reflux** ◆Prophylaxis Low dose antibiotics (trimethropin) **Surgical correction** ◆ High grade reflux IV - V ◆ Failed prophylaxis ◆ Parenchymal damage
190
Define Wilson's disease.
◆ Autossomal recessive disorder ◆ ⬇︎ Serum copper concentrations ◆ ⬆︎ Liver copper concentrations ➝ liver failure.
191
Cause of Wilson's disease?
◆ Gene mutation afecting copper transport.
192
What are the **symptoms** of `Wilson's disease`? | Copper
**Eyes:** ➔ Kayser-Fleischer rings **Liver:** ◆ Deranged liver function tests ◆ Cirrhosis **Neuro:** ◆ Ataxia ◆ Dysarthria ◆ Dystonia **Behavioural:** ◆ Personality changes ◆ ⬇︎ school perfomance
193
What are the **investigations** done in `Wilson's disease`?
◆ Liver function tests; ◆ Serum ceruloplasmin; ◆ Hepatic parenchymal copper;
194
Rx of Wilson's disease | Copper
◆ Lifelong Penicillamine ◆ Acute liver failure or cirrhosis: liver transplant
195
Describe what is **Wilm's tumour**.
◆ Renal neoplasm ◆ < 5 yo ◆ Also known as nephroblastoma.
196
Symptoms of **Wilm's tumour**.
◆ Abdominal palbable firm and smooth mass ◆ Asymptomatic
197
**Management** of `Wilm's tumour`?
◆ `Urgent referral` to paediatric team.
198
Name the **diseases** that present with `strawberry tongue`.
◆ Kawasaki disease ◆ Scarlet fever
199
Name the **paeds rashes** that present with `fever`.
**High fever:** ◆ Kawasaki ◆ Roseola ◆ Scarlet fever **Mild fever:** ◆ Measles ◆ Rubella
200
Name the **paeds rashes** that present with `lymphadenopathy`.
◆ Kawasaki ◆ Scarlet fever ◆ Rubella
201
Name the **paeds rashes** that present with `oral spots`.
**Measles:** ◆ Koplik spots (white spots oral mucosa) **Rubella:** ◆ Forchheimer spots (red macules on soft palate and tonsils)
202
Name the **paeds rashes** that present with `conjuctivitis`.
◆ Kawasaki ◆ Measles ◆ Rubella
203
What is the **age group** for `normal puberty` development?
**Girls:** ◆ 8 - 13 YO ◆ Breast begin to develop **Boys:** ◆ 9 - 14 YO ◆ Testicular enlargement
204
**Abnormal** puberty development?
**Early puberty:** `Girls:` before 8 YO `Boys:` before 9 YO **Late puberty:** `Girls:` ◆ No breast development until 13 YO ◆ Breast developed but no period until 15 YO `Boys:` ◆ No testicular development until 14 YO.
205
Describe ostogenesis imperfecta
◆ Autosomal dominant disease ◆ Defect in type 1 collagen
206
Symptoms of ostogensis imperfecta
◆ Blue sclerae ◆ ⬆︎ risk of bone fracture ◆ Teeth imperfections ◆ Hearing loss
207
When should you worry about `weight loss` in the **first few days of life**?
◆ Weight loss >10% ◆ Infant does not regain weight by week 3 of life.
208
When are live **vaccination** `contraindicated`?
◆ Immunosuppressed patients ◆ Pregnancy
209
When should **vaccination** be `delayed`?
➔ Child with fever or confirmed infection.
210
Rx of osteogenesis imperfecta
Biphosponates.
PLAB 1 August 2024
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