Paediatrics Flashcards

Question

Management of whooping cough

Answer 1

Notifiable disease Supportive care Oral macrolide if onset of cough is within 21 days - clarithromycin. Give household contacts prophylactic abx school exclusion 48 hours until after commencing ABX

Answer 2

Subconjunctival haemorrhage Bronchiectasis Seizures Pneumonia

Answer 3

Upper respiratory tract disease = oedema in the larynx Parainfluenza viruses Characterised by an inspiratory stridor Peak incidence at 6 months

Answer 4

Cough - worse at night Stridor Fever Coryzal symtpoms Increased work of breathing

Answer 5

- Single dose of oral dexamethasone 0.15mg/kg to all children regardless of severity - Prednisolone as an alternative - Adrenaline - Oxygen

Answer 6

Infection of lung tissue Inflammation of the lung tissue and sputum filling the airways and alveoli Can be seen as consolidation on CXR Bacteria, virus, or atypical bacteria such as mycoplasma

Answer 7

- Cough ( wet and productive) - High fever - Tachypnoea - Tachycardia - Increased work of breathing - Lethargy - Delirium

Answer 8

- Tachypnoea - Tachycardia - Hypoxia - Hypotension - Fever - Confusion Bronchial breath sounds - equally loud on EXPIRATION AND INSPIRATION. Caused by consolidation of lung tissue - Focal coarse crackles - Dullness to percussion

Answer 9

Strep pneumonia

Answer 10

CXR but not routinely required Viral PCR, throat swab for causative organism

Answer 11

Amoxicillin first line Macrolides will cover atypical pneumonia Oxygen if sats are <92%

Answer 12

Full blood count to check levels of various white blood cells. Chest xray to screen for any structural abnormality in the chest or scarring from the infections. Serum immunoglobulins to test for low levels of certain antibody classes indicating selective antibody deficiency. Test immunoglobulin G to previous vaccines (i.e. pneumococcus and haemophilus). Some patients are unable to convert IgM to IgG, and therefore cannot form long term immunity to that bug. This is called an immunoglobulin class-switch recombination deficiency. Sweat test to check for cystic fibrosis. HIV test, especially if mum’s status is unknown or positive.

Answer 13

Inflammation and swelling of the epiglottis Caused by infection, typically with haemophiliac influenza type B Can swell to the point of obstructing the airway completely

Answer 14

Rapid onset High temperature Sore throat and stridor Drooling of saliva Tripod position - leaning forward and extending neck in a seated position

Answer 15

Direct visualisation LAteral XRAY - thumb sign- caused by oedematous and swollen epiglottis

Answer 16

- Immediate senior involvmenet - Don’t distress patient - Endotracheal intubation - DO NOT examine the throat - Oxygen - IV ABX- Ceftriaxone - Steroids -Dexamethasone

Answer 17

Epiglottic abscess!

Answer 18

Autosomal recessive condition affecting the mucus glands Genetic mutation of the cystic fibrosis transmembrane conductor gene on chromosome 7 Most common variant = delta F508 mutation - coding for cellular Channels ( chloride)

Answer 19

- Thick pancreatic and biliary secretions that cause blockage of the ducts = lack of digestive enzymes such as pancreatic lipase in digestive tract - Low volume thick airway secretions that reduce airway clearance resulting in bacterial colonisation and susceptibility to airway infections Congenital bilateral absence of vans deferens in males ---> sperm have no way of getting from the testes to ejaculate = male infertility

Answer 20

Screened at birth with new born spot test Meconium ileus - in 20% of babies with CF, the meconium is thick and sticky and gets stuck and obstructs the bowel.

Answer 21

Chronic cough Thick sputum production Recurrent respiratory tract infections Stetorrhoea - due to lack of fat digesting enzymes Abdominal pain and bloating Parents may report the child tastes salty Poor weight and height gain Delayed puberty Nasal polyps Short DM Rectal prolapse due to bulky stools

Answer 22

- Low weight or height on growth charts - Nasal polyps - Finger clubbing - Crackles and wheezes on auscultation Abdominal distention

Answer 23

- Hereditary clubbing - Cyanotic heart disease - IE - Cystic fibrosis - TB - IBD - Liver cirrhosis

Answer 24

- New-born blood spot tests - Sweat test is the gold standard for diagnosis ○ Pilocarpine is applied to skin ○ Electrodes. Causes skin to sweat and chloride concentration is measured Diagnostic = more than 60mmol/L

Answer 25

* Staphylococcus aureus * Pseudomonas aeruginosa - particuarly hard to get rid of. Treated with nebulised abx such as tobramycin / cipro * Burkholderia cepacia* * Aspergillus

Answer 26

Chest physiotherapy (at least twice daily) to clear mucus High calorie diet Creon tablets to digest fats in patients with pancreatic insufficiency Prophylactic fluclox to reduce risk of bacterial infections Bronchiodilators such as salbutamol inhalers can treat bronchoconstriction Vaccinations - pneumococcal, influenzai and varicella Lung transplant in end stage respiratory failure Kaftrio! - homozygous for mutation. Lumacaftor/ invacaftor

Answer 27

DM, osteoporosis, vitamin D deficiency and liver failure

Answer 28

Bronchopulmonary dysplasia Occurs in premature babies typically before 28 weeks gestation Respiratory distress syndrome and require o2 therapy or intubation and ventilation at birth

Answer 29

Low o2 sats Increased work of breathing Poor feeding and weight gain Crackles and wheezes on chest auscultation Increased susceptibility to infection

Answer 30

Giving corticosteroids e.g. betamethasone to mothers that show signs of premature labour at less than 36 weeks gestation can speed up development

Answer 31

- Use CPAP rather than intubation and ventilation - Use caffeine to stimulate the resp effort

Answer 32

- Sleep stid to assess oxygen sats during sleep - Protection against RSV to reduce risk and severity of bronchiolitis Monthly injections of a monoclonal antibody - palvizumab

Answer 33

Permanent neurological problems resulting from damage to the brain around the time of birth NOT a progressive condition

Answer 34

Antenatal eg cerebral malformation, congenital infection Intrapartum - birth asphyxia Post natal - intraventricular haemorrhage, meningitis, head trauma

Answer 35

Abnormal tone, early infancy Delayed motor milestones Abnormal gait - hemiplegic, diplegia gait Increased tone and spasticity in the legs Feeding difficulties Signs of UMN lesion = good muscle bulk, increased tone, brisk reflexes, reduced power Non motor problems- learning difficulties, epilepsy, squints and hearing problems

Answer 36

Spastic - Dyskinetic Ataxic Mixed

Answer 37

Physio Speech and language Dieticians Spasticity OT Antiepileptic Glycopyronium bromide

Answer 38

Muscle bulk preservation, hypertonia, power is slightly reduced, and reflexes are brisk

Answer 39

Reduced muscle bulk with fasciculation, hypotonia, dramatically reduced power, reduced reflexes

Answer 40

Seizures provoked by fever Typically occur between ages of 6 months and 5 years

Answer 41

Occur early in viral infection Last less than 5 minutes Tonic clonic

Answer 42

<15 minutes Generalised seizure Typically no reoccurrence within 24 hours Once during single febrile illness Complete recovery within an hour

Answer 43

15-30 minutes Partial or focal seizures Repeat seizures within 24 hours/ multiple times during febrile illness

Answer 44

>30 minutes of seizure

Answer 45

Control fever Stay with child, pillow under their head Call ambulance if lasting more than 5 minutes If recurrent - benzodiazepine rescue medication may be considered

Answer 46

Typically no lasting damage Slightly higher risk of developing epilepsy

Answer 47

Transient episodes of abnormal electrical activity

Answer 48

tonic= muscle tensing clonic = muscle jerking Tonic before the clonic May be associated tongue biting, incontinence, groaning or irregular breathing Prolonged post ictal period - where confused, drowsy, irritable or low

Answer 49

First line - sodium valproate Second line - lamotrigine or carbamezepine

Answer 50

Start in temporal lobes Affect speech, hearing, memory and emotion Hallucinations, memory flashbacks, deja vu

Answer 51

Reverse of tonic clonic? First line = carbamazepine or lamotrigine Second line = sodium valproate

Answer 52

Becomes blanks, stares into space for 10-20 seconds Most stop having these as they get older

Answer 53

Sodium valproate or ethosuximide

Answer 54

Drop attacks Lapses in muscle tone Don't usually last for more than 3 minutes - may be indicative of Lennox gastaut syndrome

Answer 55

First line - sodium valproate Second line - lamotrigine

Answer 56

Sudden brief muscle contractions Remain awake Juvenile myoclonic epilepsy

Answer 57

First line - sodium valproate Second line - Iamotrigine, levetiracetam or topiramate

Answer 58

West syndrome Starting around 6 months Clusters of full body spasms Poor prognosis

Answer 59

Prednisolone or igabatrin

Answer 60

EEG- after the second simple tonic clonic seizure MRI brain considered when first seizure is in children under 2, focal seizures or no response to first line anti epileptic medications

Answer 61

Increases activity of GABA, which relaxes the brain

Answer 62

Teratogenic, liver damage, hepatitis, hair loss, tremors

Answer 63

Agranulocytosis, aplastic anaemia, induces the p450 system = drug interactions

Answer 64

Folate and vitamin D deficiency, megaloblastic anaemia ( folate deficiency), osteomalacia ( vitamin D deficiency)

Answer 65

Night terrors and rashes

Answer 66

Seizure lasting more than 5 minutes, or 2 or more seizures without regaining consciousness in the interim IV lorazepam, high concentration o2, check blood glucose levels IV phenobarbital or phenytoin if seizures persist

Answer 67

Transient loss of consciousness due to a disruption of blood flow to the brain, often leading to a fall Vasovagal episodes/ fainting

Answer 68

Problem with the autonomic nervous system regulating blood flow to the brain. When the vagus nerve receives a strong stimulus Can stimulate the parasympathetic nervous system Blood pressure in the cerebral circulation drops = hypoperfusion of brain tissue = faint

Answer 69

Dehydration Missed meals Response to stimuli

Answer 70

- Hypoglycaemia - Dehydration - Anaemia - Infection - Anaphylaxis - Arrythmias - Valvular heart disease - HOCM

Answer 71

Vasovagal Situational - cough, micturition Carotid sinus syncope

Answer 72

Primary autonomic failure e..g Parkinson's, lewy body Secondary autonomic failure e..g diabetic neuropathy Drug induced e.g. alcohol, diuretics Volume depletion e.g. haemorrhage, diarrhoea

Answer 73

- Arrythmias - bradycardias, tachycardias - Structural - MI, HOCM - Ohers- PE

Answer 74

- CV exam - ECG - Echo - structural hear disease - Bloods NOTE: patients with typical features, no postural drop and a normal ecg don’t require further investgiations

Answer 75

Breath holding attacks Involuntary episodes when a child holds their breath Usually triggered by something upsetting or scarring them 6-18 months old

Answer 76

Occur when a child is really upset, worked up and crying After letting out a long cry - loose consciousness. Within a minute they regain it

Answer 77

Occur when a child is startled heart stops beating Pale, consciousness los Within 30 seconds, the heart restarts and child becomes conscious again

Answer 78

- Iron deficiency anaemia is linked? Exclude other pathology, educate parents

Answer 79

Paracetamol, sumatriptan, antiemetics

Answer 80

Propranolol, pizotifen, topiramate

Answer 81

When the eyes are not aligned, experience double vision May lead to amblyopia - when one eye becomes more dominant and other ignores ( lazy eye)

Answer 82

Differences in control of extra ocular muscles

Answer 83

Due to paralysis of extra ocular muscles

Answer 84

Usually idiopathic Hydrocephalus Cerebral palsy Space occupying lesions e.g. retinoblastoma Trauma

Answer 85

Cover test - observing movement of uncovered eye Corneal light reflecting test - holding a light source from 30cm from the child's face to see if the light reflects symmetrically on teh pupils

Answer 86

Referral to secondary care Eye patches

Answer 87

When skull sutures close prematurely Results in abnormal head shapes and restriction to the growth of the brain If left untreated - leads to raised ICP, resulting symptoms of developmental delay, cognitive impairment, vomiting, irritability XRAY skull and surgical reconstruction

Answer 88

Genetic conditions that cause gradual weakening and wasting of muscles X linked recessive

Answer 89

Children with proximal muscle weakness use a specific technique to stand up from a lying position Get up from downward dog, muscles around pelvis aren't strong enough without the help of their arms

Answer 90

Lots of OT, physio and medical appliances

Answer 91

Defective gene for dystrophin on the X chromosome Dystrophin is a protein that holds muscles together at cellular level Calf psuedohypertrophy Life expectancy 25-35 years Investigations = raised CK and genetic testing

Answer 92

Autosomal recessive condition that causes a progressive loss of motor neurones, leading to progressive muscular weakness Affects the lower motor neurones in the spinal cord.

Answer 93

Fasciculations, reduced muscle bulk, reduced tone, reduced power and reduced or absent reflexes.

Answer 94

Type 1 - onset in the first few months of life, usually progressing to death within 2 years Type 2 - onset within the first 18 month . Most never walk but survive to adulthood Type 3 - Onset after first year of life. Most walk without support, but subsequently loose the ability. Respiratory muscles are less affected and life expectancy is close to normal Type 4- onset in the 20s, most retains ability to walk short distances, but require a wheelchair for mobility

Answer 95

- No cure - Physiotherapy can help to maximise strength of muscles - Resp support - PEG feeding when weak swallow = unsafe swallow

Answer 96

CSF build up within the brain and spinal cord overproduction of CSF or problem with draining CSD

Answer 97

CSF created in the 4 choroid plexusus ( one in each ventricle) CSF absorbed into the venous system by the arachnoid granulations

Answer 98

Aqueductal Stenosis - most common, insufficient drainage of CSF, Cerebral aqueduct that connects the 3rd and 4th ventricle is stenosed Blocks normal flow of CSF out of the 3rd = builds up in the lateral and 3rd ventricles Arachnoid cysts Arnold-chiari malformation -where cerebellum herniates downwards through the foramen magnum, blocking CSF outflow Chromosomal abnormalities and congenital malformations can cause obstruction to CSF damage

Answer 99

Cranial bones in babies arent fused at sutures till 2 Skull can expand, get and enlarged and rapidly increasing head circumference. Bulging anterior fontanelle Poor feeding and vomiting Poor tone Sleepiness

Answer 100

Ventriculoperitoneal shunt VP shunt that drains CSF from ventricles into antoher body cavity = mainstay

Answer 101

Chronic atopic condition Inflammation, defects in the barrier that the skin provides Dry Typically presents before 2 years Flexor - insides of elbows and knees

Answer 102

- Avoid irritants - Emollients ○ E45, aveeno, hydromol, - Topical steroids ○ Hydrocortisone, eumovate, betnovate, demovate ○ Be careful of skin thinning - Wet wrapping ○ Severe cases Large amounts of emollient under wet bandages

Answer 103

- Severe infection caused by HSV 1 or 2 OR VZV - Rapidly progressing painful rash, often in children that have eczema - Monomorphic, circular, depressed ulcerated, punched out erosions, usually 1-3mm IV aciclovir

Answer 104

Chronic autoimmune condition Red scaly patches on skin Genetic - associated with HLA-b13 EXTENSOR - knees and elbows, also scalp

Answer 105

: the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp

Answer 106

In contrast to plaque psoriasis the skin is smooth

Answer 107

Transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body

Answer 108

Commonly occurs on the palms and soles

Answer 109

Ausptiz sign - bleeding when plaques are scraped off Keobner phenomenon - development of psoriatic lesions to areas of skin affected by trauma Residual pigmentation of the skin after the lesions resolve

Answer 110

- Topical potent corticosteroid once daily + vitamin D anaolgue once daily - Topical vitamin D analogues - calcipotriol - Topical dithranol Tacrolimus in adults

Answer 111

- Chronic inflammation in the pilosebaceous unit - Increased production of sebum which traps keratin and blocks unit - Comedones - swollen and inflammed units inflammatory lesions form when the follicle bursts releasing irritants Papules and pustules

Answer 112

Mild acne: open and closed comedones with or without sparse inflammatory lesions Moderate acne: widespread non inflammatory lesions and numerous papules and pustules Severe acne: extensive inflammatory lesions, may include nodules, pitting and scarring

Answer 113

* 12 week course of topical combination therapy e.g. a fixed combination of topical adapalene with topical benzoyl peroxide

Answer 114

2 week course of: - a fixed combination of topical adapalene with topical benzoyl peroxide - a fixed combination of topical tretinoin with topical clindamycin - a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline - a topical azelaic acid + either oral lymecycline or oral doxycycline

Answer 115

- Highly contagious via respiratory droplets - 10-12 days post exposure - get symptosm - Fever, coryzal symptosm and conjunctivitis - Kopli spots = greyish white spots on the buccal mucosa - Rash starts on the face, erythematous macular rash - Notifiable - Resolves on its own. - Isolate until 4 days after symptoms resolve

Answer 116

- Group A strep infection, usually tonsilitis - Red pink blotchy macular rash with rough sandpaper skin - Strawberry tongue, lymphadenopathy - Pen V - Notifiable - Off school until 24 hours after starting abx

Answer 117

- Resp droplets - Milder erytehmatous rash - Lymphadenopathy - Notifiable. Avoid pregnant women - Stay off school till at least 5 days post rash resolving

Answer 118

Red rash on cheeks - slapped cheeks Don’t need to stay off school Reticular(net like) midly erythematous rash on trunk and limbs Mild fever, and coryszal symptoms Complications = aplastic anaemia

Answer 119

- Caused by HHV 6 - HIGH FEVER!!. Rash on trunk arms, legs, not itcy Complication = febrile convulsions

Answer 120

Erythematous rash caused by hypersensitivity reaction Herpes simplex virus is most common cause. Also - mycoplasma, penicillin, nsaids, SLE, sarcoid Itchy, erythematous rash.

Answer 121

Target lesions Initially seen on the back of the hands/feet before spreading to the torso Upper limbs more commonly affected than lower limbs Pruritus is occasionally seen and is usually mild Stomatitis - sore mouth Erythema multiforme major is associated with mucosal involvement

Answer 122

Identify underlying cause - e.g. CXR to check for e.g. mycoplasma pneumonia Most of the time resolves spontaneously, may be assoicatd with recurrent soldsores IV fluids and analgesia if affecting mucosa - e.g. oral mucosa

Answer 123

Hives! Features - Pale, pink raised skin - Pruitic - Histamine release Can be acute or chronic

Answer 124

- Non sedating antihistamines - loratadine or certirizine - Sedating antihistamine might be considered at night time - chlorphenamine Prednisolone used for severe or resistant

Answer 125

- Generalised vesicular rash. - Highly infectious.. Spread via respiratory route/ direct contact with lesions - Shingles = reactivation of the dormant virus in dorsal root ganglion

Answer 126

- Fever often first symptoms - Infectivity = 4 days before rash until 5 days after - Itch, rash starting on head/trunk before spreading. Vesciular blistering

Answer 127

- Bacterial superinfection - Dehydration - Conjunctival lesions - Pneumonia - Encephalitis - presenting as ataxia

Answer 128

- Calamine lotion - Infectivity continues until all the lesions are dry and crusted over = school exclusion - Aciclovir may be considered in immunocompromised - Chlorphenamine ( antihistamine Common complication is secondary bacterial infection of the lesions - NSAIds may increase the risk - On small number - invasive group A streptococcal soft tissue infections may occur = necrotising fasciitis

Answer 129

Coxsackie A virus Presentation Viral upper resp tract symptoms After 1-2 days - small mouth ulcers, followed by blistering red spots Painful mouth ulcers

Answer 130

Supportive! HIGHLY contagious- advise about sharing towels etc

Answer 131

- Dehydration - Encephalitis - Bacterial superinfection

Answer 132

Skin infection caused by molluscum contagiosum virus - poxvirus Features - Small, flesh coloured papules that each have a central dimple - Crops! - Spread through direct contact or sharing towels/ bedsheets

Answer 133

- Resolve by themselves - Exclusion from school etc not necessary - If bacterial superinfection occurs - then you might give oral fluclox - Refer for people with HIV who have extensive lesions.

Answer 134

thought that herpes hominis virus 7 may play a role Generalised, self limiting rash Minority may have prodromal history of headache/ erecent viral infection Herald patch, usually on the trunk FIR TREE APPERANCE! (arrangement following lines of the ribs) - faint pink oval lesions.

Answer 135

Usually disappears after 6-12 weeks

Answer 136

Inflammatory skin condition affecting the sebaceous glands Affects areas that have these glands - scalp, nasolabial folds, eyebrows Cradle cap = crusted dry flaky scalp.

Answer 137

Reassurance, usually resolves in a few weeks Baby oil, petroleum jelly on scalp For body and face - clotrimazole anti fungal cream may be used

Answer 138

Fungal infection. Athletes foot/ tine capitits/ tine corpus Itchy rash that is erythematous, scaly and well demarcated One or several ring or circular shaped areas that spread outwards

Answer 139

- Anti fungal medications Creams - Clotrimazole and miconazole Shampoos - ketoconazole for tinea capitis Oral anti fungal medcations e.g. flucanozone

Answer 140

Delayed changing of nappies Irritant soap products Certain types of nappies Diarrhoea Oral abx predispose to candida infection Pre term infants

Answer 141

- Rash extending into the skin folds - Larger red macules - Well demarcated scaly border - Circular pattern to the rash spreading outwards, similar to ringworm Satellite lesions, which are small similar patches of rash or pustules near the main rash

Answer 142

Switching to highly apsobent nappies Change nappy and clean after wetting or soiling Maximise time not wearing one Barrier cream Infection with candida or bacteria = clotrimazole or fusidic acid cream/ oral fluclox

Answer 143

Caused by a mite Sarcoptes scabiei and is spread by prolonged skin contact Typically affects children and young adults Can take up to 8 weeks for any symptoms/ rash to occur Itchy small red spots, tack marks where mites have burrowed Finger webs!

Answer 144

- Permethrin 5% - Mathathion is second line - Oral ivermectin is a single dose that can be repeated if difficult to treat - All household contacts should be treated even if asymptomatic - Pruitis persists for up to 4-6 weeks post eradication - WASH CLOTHES

Answer 145

- Serious infestation with scabies in patients that are immunocompromised - Extremely contagious - Scaly plaques - May not have an itch - Oral ivermectin admission and isolation

Answer 146

- Malathion - Wet combing - Dimeticone 4% lotion can be put on head left overnight - Houshold contacts don’t need to be treated unless they are also affected

Answer 147

Bleeding under the skin! Doesn’t fade when pressed

Answer 148

Meningococcal septicaemia HSP - purpuric rash on the legs and buttocks, may have associated abdo/joint pain ITP - develops over several days, in otherwise well child Acute leukaemia HUS - associated with oliguria Mechanical - strong coughing, vomiting etc can produce petechiae in superior vena cava distribution Traumatic - tight pressure Viral illness - influenza/ enterovirus

Answer 149

Inflammation of the subcutaneous fat on the shins Inflammation of fat = panniculitis Caused by a hypersensitivity reaction Usually over the shins, usually resolves within 6 weeks and lesions heal without scarring

Answer 150

- Infection ○ Streptococci ○ TB - Systemic disease ○ Sarcoidosis ○ IBD - Malignancy - Drugs ○ Penicillin's ○ COCP - Pregnancy

Answer 151

- Inflammatory markers - ESR and CRP - Throat swab for strep infection - CXR - Stool microscopy and culture - Faecal calprotectin for IBD

Answer 152

Management dependent on underlying cause Managed conservatively May use steroids to settle inflammation

Answer 153

Superficial bacterial skin infection usually cased by either staph aureus or streptococcus pyogens Primary infection or complication of an existing skin condition CONTAGIOUS - no school until lesions are crusted or 48 hours after commencing abx Either bullous or non bullous

Answer 154

- Golden crusted lesions typically round the mouth - Very contagious - Exudate - Bullous is always caused by staph aureus = fluid filled vesicles

Answer 155

- Hydrogen peroxide 1% cream for people who are not systemically unwell - If not suitable - topical fusidic acid - Extensive disease - oral fluclox / erithyromycin if penicillin allergic

Answer 156

- Cellulitis - Sepsis - SSSS - Post streptococcal glomerulonephritis

Answer 157

Condition caused by a type of staphylococcus aureus that produces epidermyoltic toxins Protease enzymes that break down the proteins that hold skin cells together. Often children <5

Answer 158

Patches of erythema on the skin Skin looks thin and wrinkled. Formation of fluid filled blisters called bullae- these burst and leave sore erythema skin Nikolsky sign - gentle rubbing of the skin causes it to peel away. Systemic symptoms- fever, irritability, lethargy, dehydration, sepsis

Answer 159

Admission and treatment with IV ABX Electrolyte balances and fluids

Answer 160

SJS = <10% of body surface area TEN = >10 %

Answer 161

Pheyntoin (TEN) Penicillins Sulponamides ( SJS) NSAIds HSV HIV

Answer 162

Rash maculopapular with target lesions being characteristic Nikolsky sign positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently Mucosal involvement Systemic symptoms

Answer 163

- Hospital admission - May have volume loss and electrolyte derangement IV immunoglobulins

Answer 164

Muocutaenous lymph node syndrome Systemic, medium sized vessel vasculitis Affects young children under 5

Answer 165

Persistent high fever for more than 5 days CRASH +burn C- conjunctivitis R- rash A - adenopathy ( lymph nodes swollen) S - strawberry tongue H - hand and feet swelling + demarcation ( desquamation = skin peeling) And burn / fever for more than 5 days NOTE coronary artery aneurysms as a complication

Answer 166

Acute - most unwell, with fever, rash and lymphadenopathy. Lasting 1-2 weeks Subacute - acute symptoms settle. Desquamation and arthralgia occur and risk of coronary artery aneurysms forming Convalescent - remaining symptoms settle, blood tests slowly return to normal and coronary aneurysms may regress

Answer 167

High dose aspirin to reduce thrombosis risk IV immunoglobulins to reduce risk of coronary artery aneurysms Echocardiogram

Answer 168

Risk of Reyes syndrome

Answer 169

Autoimmune inflammation Arthritis without any other cause, lasting more than 6 weeks in a patient under the age of 16 Joint pain, swelling and stiffness

Answer 170

Inflammatory Subtle salmon pink rash, high swinging fevers, enlarged lymph nodes, weight loss, joint inflammation, splenomegaly, muscle plain, pleuritis and pericarditis

Answer 171

Macrophage activation syndrome (MAS) … severe activation of the immune system with massive infalmmatory resonse = DIC, anaemia thrombocytopenia, bleeding, low ESR, non blanching rash

Answer 172

Idiopathic inflammatory arthritis in 5 joints or more Symmetrical, can affect the small joints of the hand and feet+ large joints such as hips and knees Can get mild fever, anaemia and reduced growth Equivilent of RA in adults. Most children negative for rheumatoid factor and described as seronegative.

Answer 173

4 joints or less Usually only affects a single joint Anterior uveitis ANA often positive, Rheumatoid factor negative No systemic symptoms or inflammatory markers

Answer 174

More common in male children over 6 years Inflammatory arthritis Enthesis's - inflammation of the point where the tendon inserts into a bone HLA b27 gene Psoriasis, IBD, anterior uveitis

Answer 175

- NSAIDs - Steroids - oral, intramuscular, intraarticular - DMARDs - methotrexate, sulfasalazine Biological therapy e..g inflixamab

Answer 176

IgA mediated small cell vasculitis - presents with purpuric rash affects lower limbs and buttocks in children Inflammation occurs in affected organs due to IgA deposits in the blood vessels Degree of overlap with IgA nephropathy Affects skin, kidneys and GI tract Usually seen post infection

Answer 177

Palpable purpuric rash ( with localised oedema) over buttocks and extensor surfaces in arms and legs Abdo pain - note Gi haemorrhage, intususcpetion and bowel infarction Polyarthritis Kidneys - IgA nephritis

Answer 178

- Exclude: meningogoccoal septicaemia, leukaemia, ITP and haemolytic uraemic syndrome - FBC - Renal profile Serum albumin - CRP - Urine dipstick - BP

Answer 179

Supportive Analgesia Monitor BP and urinalysis should be monitored Around 1/3 of patients have a relapse

Answer 180

Group of genetic conditions involving defects in collagen, causing hyper mobility of the joints and elasticity of the skin Type III collagen affected

Answer 181

Elastic, fragile skin Joint hypermobility - recurrent dislocation Easy bruising Stretch marks Aortic regurgitation, aortic dissection and mitral valve prolapse SAH Chronic pain

Answer 182

Can occur with hypermobile EDS resulting from autonomic dysfunction Tachycardia occurs on sitting/standing and symtoms include: Presyncope Syncope Headaches Disorientation Nausea Tremor

Answer 183

Used in EDS for assessing hypermobility Maximum score of 9 Hyperextending

Answer 184

Physiotherapy to strengthen and stabilise the joints OT Moderating activity to minimise flares Psychology

Answer 185

Develops following an immunological reaction to a recent (2-4 weeks) streptococcus pyrogens infection Autoimmune! Caused by antibodies created against the streptococcus bacteria that also target tissues in the body

Answer 186

Rheumatic fever is caused by group A beta haemolytic streptococcal - typically streptococcus pyogens causing tonsilitis. Immune system creates antibodies to fight the infection. They not only target the bacteria, but also match antigens on the cells of the persons body eg the muscle cells in the myocardium in the heart. Type 2 hypersensitivity reaction. Immune system begins attacking cells throughout the body. Process is usually delayed 2-4 weeks after the initial infection

Answer 187

Sore throat, rash, arthritis, murmur Often 2-4 weeks post tonsillitis SOB, nodules Joint involvement - migratory joints become inflamed and improve at different times Carditis - tachycardia, murmurs from valvular heart disease, pericardial rub on auscultation Skin involvement - subcutaneous nodules Nervous system - chorea (irregular, uncontrolled and rapid movements of the limbs)

Answer 188

Throat swab for bacterial culture ASO antibody titres Echocardiogram, ECG

Answer 189

A RF diagnosis can be made when theres evidence of a recent streptococcal infection 2 major criteria OR one major and 2 minor criteria

Answer 190

JONES- FEAR Major criteria J- joint arthritis O- organ inflammation N- nodules E- erythema marginatum rash S - synedra chorea Minor criteria F- fever E- ECG changes ( prolonged PR interval ) without carditis A- arthralgia without arthritis R - raised inflammatory markers ( CRP and ESR)

Answer 191

Pen V Anti inflammatory - NSAIDs Treatment of complications e.g. HF

Answer 192

Reoccurrence Valvular heart disease - notably mitral stenosis Chronic HF

Answer 193

Autoimmune condition where exposure to gluten causes immune reaction that creates inflammation in the small intestine Develops in early childhood Autoantibodies are created in response to exposure of gluten - anti TTG and anti EMA.

Answer 194

Often asymptomatic Failure to thrive Diarrhoea, fatigue, weight loss, mouth ulcers, anaemia secondary to iron, b12 or folate deficiency Dermatitis herpetiformis on the abdomen RARELY can present with neurological symptoms: peripheral neuropathy, cerebellar ataxia, epilepsy

Answer 195

Coeliac disease! As they are often linked

Answer 196

HLA - DQ2 gene HLA - DQ8 gene

Answer 197

MUST continue the investigations while the patient is on a gluten diet Check IgA Anti TTG anitbodies Anti EMA Endoscopy and intestinal biopsy will show crypt hypertrophy and villous atrophy

Answer 198

* Vitamin deficiency * Anaemia * Osteoporosis * Ulcerative jejunitis * Enteropathy-associated T-cell lymphoma (EATL) of the intestine * Non-Hodgkin lymphoma (NHL) * Small bowel adenocarcinoma (rare)

Answer 199

* Type 1 diabetes * Thyroid disease * Autoimmune hepatitis * Primary biliary cirrhosis * Primary sclerosing cholangitis Down’s syndrome

Answer 200

A lifelong gluten free diet is essentially curative. Relapse will occur on consuming gluten again. Checking coeliac antibodies can be helpful in monitoring the disease.

Answer 201

Less than 3 stools a week Hard stools difficult to pass Rabbit dropping Straining and painful Holding an abnormal posture - retentive posturing Rectal bleeding associated with hard stools Faecal impaction causing overflow soiling with incontinence of particularly loose stools May be able to palpate in abdomen

Answer 202

Faecal incontinence Not pathological until 4 years of age Sign of chronic constipation where the rectum becomes stretched and looses sensation Hard stools remain in the rectum, and only loose stools are able to bypass the blockage and leak out = soiling

Answer 203

Spina bifida, Hirschsprungs disease, cerebral palsy, learning disability, psychosocial stress, abuse

Answer 204

- Developing a habit of not opening bowels and ignoring sensation - Over time loose the sensation - Start to retain faeces - Faecal impaction- rectum stretches as it fills - Desensitisation of the rectum - More difficult to treat the constipation and reverse the problem

Answer 205

Hirschsprungs, CF (particuarly meconium Ileum), hypothyroidism, spinal cord lesions, sexual abuse, intestinal obstruction, anal stenosis, cows milk intolerance

Answer 206

Not passing meconium within 48 hours of birth - CF or hirschsprungs disease Neurological signs Vomiting - obstruction or hirschsprungs Ribbon stool - stenosis Abnormal anus - stenosis, IBD, sexual abuse Failure to thrive - coeliac, hypothyroid, safe guarding Acute severe abdo pain and bloating- obstruction or intussuspection

Answer 207

- Treat underlying cause - High fibre diet and good hydration - MOVICOL is first line laxative - Faecal impaction may require dis impaction regimen with high dose laxatives Encourage and praise visiting toilet

Answer 208

- Constipation - UTI - Coeliac - IBD - IBS - Mesenteric adenitis - Abdominal migraine - Pyelonephritis - Henoch schonlein purpura DKA

Answer 209

Appendicitis- spreads from central to right iliac fossa Intussusception - colicky non specific abdo pain, redcurrant jelly stool Bowel obstruction - pain, distention, constipation and vomiting Testicular torsion - sudden onset, unilateral testicular pain, nausea and vomiting

Answer 210

Persistent or bilious vomiting, severe chronic diarrhoea, fever, rectal bleeding, weight loss, dysphagia, night-time pain, abdominal tenderness

Answer 211

- Episodes of central abdomianl pain lasting more than 1 hour - Nausea and vomiting, anorexia, pallor, headache, photophobia, aura May occur in young children before developing traditional migraines as they get older

Answer 212

Management : explanation, education, treating acute attacks, preventative measures Acute attack: low stimulus, paracetemol, ibuprofen Prevention: pizotifen ( serotonin antagonist, withdraw slowly as associated with withdrawal symptoms eg depression, anxiety, poor sleep and tremor), propranolol etc

Answer 213

The contents of the stomach reflux through the lower oesophageal sphincter into the oesphaegous, throat and mouth In babies - there's a immaturity of the lower oesphageal sphincter which allows stomach contents to easily reflux. NORMAL for babies if theres normal growth, usually improves as they grow.

Answer 214

- Preterm delivery - Neurological disorders

Answer 215

Normal for babies to have some reflux after larger feeds, becomes more troublesome when this causes them to become distressed Signs of problematic reflux: - chronic cough - hoarse cry - distress - reluctance to feed - pneumonia - poor weight gain

Answer 216

- Small frequent feeds - Burping - Not over feeding Keep upright

Answer 217

- Distress - Failure to thrive - Aspiration Frequent otitis media

Answer 218

* Not keeping down any feed (pyloric stenosis or intestinal obstruction) * Projectile or forceful vomiting (pyloric stenosis or intestinal obstruction) * Bile stained vomit (intestinal obstruction) * Haematemesis or melaena (peptic ulcer, oesophagitis or varices) * Abdominal distention (intestinal obstruction) * Reduced consciousness, bulging fontanelle or neurological signs (meningitis or raised intracranial pressure) * Respiratory symptoms (aspiration and infection) * Blood in the stools (gastroenteritis or cows milk protein allergy) * Signs of infection (pneumonia, UTI, tonsillitis, otitis or meningitis) * Rash, angioedema and other signs of allergy (cows milk protein allergy) - Apnoeas are a concerning feature and may indicate serious underlying pathology and need urgent assessmen

Answer 219

Presents in 2nd to 4th weeks of life with vomiting Caused by hypertrophy of the circular muscles of the pylorus Pyloric sphincter is a ring of smooth muscle that forms the canal between the stomach and duodenum. Hypertrophy of the pylorus = pyloric stenosis. After feeding, powerful peristalsis in the stomach as it tried to push food into the duodenum and eventually it comes so powerful it ejects the food into the oesophagus

Answer 220

- Projectile vomiting 30 mins after feed - Peristalsis palpable mass - Hypochoraemic, hypokalaemia alkalosis due to persistent vomiting ( as HCL is going ) Constipation/ dehydration

Answer 221

USS to visualise

Answer 222

Ramstedt Pyloromyotomy

Answer 223

Bile duct is either narrowed or absent Cholestasis = bile cannot be transported from the liver to the bowel Prevents excretion of conjugated bilirubin

Answer 224

Presents shortly after birth with significant jaundice Appetite and growth disturbance Jaundice Hepatomegaly

Answer 225

Conjugated bilirubin is abnormally high LFTs Sweat test ?CF

Answer 226

Surgical management IS THE ONLY DEFINITIVE TREATMENT Kasai portoenterostomy - Attaching a small section of the intestine to the opening of the liver where the bile duct normally attaches.

Answer 227

Meconium ileus Hirschsprungs Oesophageal atresia Intusscpetion

Answer 228

Persistent vomiting, may be bilious Abdo pain and distention Failure to pass stool or wind Abnormal bowel sounds, can be high pitched an tinkling in the early obstruction and absent later

Answer 229

Congenital condition where nerves of myenteric plexus are absent in the distal bowel and rectum Brain of the gut Nerve plexus runs all the way along the bowel in the bowel wall, responsible for stimulating peristalsis

Answer 230

More common in males Family history Downs syndrome, NF, MEN II

Answer 231

Delay in passing meconium Constipation, abdominal distention, abdominal pain, vomiting and poor weight gain

Answer 232

- Inflammation and obstruction of intestine - Presents within 2-4 weeks of birth - Fever, abdo distention and diarrhoea and features of sepsis - Toxic megacolon and perforation of the bowel can occur Requires urgent ABX, fluid resuscitation and decompression of the obstructed bowel

Answer 233

- Abdo xray Rectal biopsy - absence of ganglionic cells

Answer 234

Initially - rectal washouts/ bowel irrigation Definitive = surgery to affected segment of the colon

Answer 235

Central abdominal pain, moves to the right iliac fossa. Mcburneys point. Loss of appetite Nausea and vomiting Rovsigns sign - palpation of the left iliac fossa causes pain in the RIF Guarding on abdominal palpation Rebound tenderness - peritonitis

Answer 236

Ectopic, ovarian cyst, meckels diverticulum, mesenteric adentiis, appendix mass

Answer 237

Telescoping of the bowel Most common in the ileocaecal region Boys are more affected

Answer 238

Concurrent viral illness Henoch schleim purpura Cystic fibrosis Intestinal polys Meckel diverticulum

Answer 239

Severe colicky abdominal pain Pale, lethargic and unwell child Redcurrant jelly stool - late sign Right upper quadrant mass on palpation - sausage shaped Vomiting

Answer 240

AIr insufflation under radiological control If fails or signs of peritonitis ---> surgical

Answer 241

Obstruction Gangrenous bowel Perforation Death

Answer 242

Around 1-2 months.

Answer 243

VSD Right ventricular hypertrophy - from trying to pump the blood against resistance of the light ventricle and pulmonary stenosis Right ventricular outflow tract obstruction - pulmonary stenosis = more resistance - blood would rather take the VSD route = more cyanosis Overriding aorta = Entrance to the aorta is further right. When the right ventricle contracts and sends blood upwards, the aorta is in the direction of the travel meaning more deoxygenated blood enter the aorta from the right side of the heart

Answer 244

Right to left cardiac shunt Blood bypasses the child's lungs Cyanosis Degree depends on severity of pulmonary stenosis

Answer 245

Rubella infection Increased age of mother Alcohol consumption at pregnancy Diabetic mother

Answer 246

Cyanosis - hyper cyanotic tet spells Right to left shunt Ejection systolic murmur - pulmonary stenosis Boot shaped heart on CXR, ECG shows right ventricular hypertrophy Echocardiogram - doppler flow

Answer 247

Surgical repair Cyanotic episodes - use prostaglandin infusion to maintain the ductus arterisosus in neonates

Answer 248

Most likely congenital heart defect to be found at adulthood Defect in septum between the 2 atria Left and right are connected during pregnancy and get a problem with them

Answer 249

Patent foramen ovale - when it fails to close Ositum secundum - where the septum secundum fails to close Otisum primum - where the septum primum fails to close

Answer 250

Stroke - in the context of DVT- normally when patients have a DVT that becomes an embolus it travels through right side of heart to the lungs and becomes a PE With ASD, the clot is able to travel across the left side of heart = systemic circulation =- brain and stroke!!!!

Answer 251

Ejection systolic murmur Fixed split second heart sound SOB, difficulty feeding, poor weight gain, LRTI

Answer 252

Echocardiogram Active monitoring, percutaneous catheter closure via femoral vein or open heart surgery

Answer 253

Congenital hole between 2 ventricles Commonly associated with downs syndrome and turners syndrome

Answer 254

May be picked up on antenatal scans Typical symptoms: Poor feeding Dyspnoea Tachypnoea Failure to hive PAN SYSTOLIC MURMUR - louder in smaller defects

Answer 255

Nutritional support Medication for HF - e.g diuretics

Answer 256

Connects the pulmonary artery with the aorta allowing blood to bypass the lungs Stops functioning within 3 days of birth and closes entirely within the first 3 weeks of life - PDA is when it fails to close

Answer 257

More common In premature babies, born at high altitude or maternal rubella infection in the first trimester May be related to genetic - downs syndrome Prostaglandins keep it open during pregnancy - note

Answer 258

SOB Small - may not have have any abnormal heart sounds Larger = continuous machinery murmur Large volume, bounding, collapsing pulse Left sub clavicular thrill Wide pulse pressure Apex beat heaving Difficulty feeding Poor weight gain

Answer 259

Echocardiogram Medical closure = indomethacin or ibuprofen.. inhibits prostaglandins synthesis. Endovascular procedures/ open surgery

Answer 260

VSD, ASD, PDA, transposition of the great arteries

Answer 261

Reversal of left to right shunt in congenital heart defect due to pulmonary hypertension Occurs when an uncorrected left to right leads to remodelling of the pulmonary micro vasculature - eventually leads to obstruction in pulmonary blood and pulmonary hypertension. Deoxygenated blood bypasses the lungs and enters the body Cyanosis

Answer 262

ASD VSD Patent ductus arteriosus

Answer 263

- Right ventricular heave - Loud p2 - Raised JVP - Peripheral oedema

Answer 264

Restricting blood flow from left ventricle into the aorta Can be asymptomatic May get fatigue, SOB, dizziness, fainting Symptoms worsen on exertion

Answer 265

Ejection systolic murmur

Answer 266

Echocardiogram Surgery

Answer 267

When the pulmonary valve becomes thickened

Answer 268

Often completely asymptomatic adn discovered as an incidental finding of a murmur Can get fatigue, SOB and dizziness

Answer 269

EJS heard loudest at pulmonary area Palpable thrill in pulmonary area Right ventricular heave due to right ventricular hypertrophy Raised JVP with giant a waves

Answer 270

Echocardiogram Watch and wait for mild Surgery for symptomatic /sever

Answer 271

Tricuspid valve is set lower to the right side of the heart, causing a bigger right atrium and a smaller right ventricle Leads to poor flow from the right atrium to the right ventricle = poor flow to teh pulmonary vessels

Answer 272

Evidence of heart failure - gallop rhythm - poor feeding - cyanosis - collapse/ cardiac arrest

Answer 273

When the attachments of the aorta and pulmonary trunk are swapped Right ventricle pumps blood into the aorta ada the left ventricle pump blood into the pulmonary vessels 2 separate circles don’t mix! After birth the condition is immediately life threatening as there's no connection between the systemic circulation and pulmonary circulation. Baby will be cyanosed Immediate survival depends on shunt between systemic circulation and pulmonary circulation to allow blood to get oxygenated by the lungs - e.g. ASD or VSD or PDA

Answer 274

- Often diagnosed during pregnancy with antenatal USS - Cyanosis - Tachycardia - Loud single S2 - Prominent right venticular impulse

Answer 275

- Maintenance of the ductus arteriosus with prostaglandins Surgical correction

Answer 276

Streptococcus pneumoniae

Answer 277

Ear pain, reduced hearing, upper airway infection symptoms eg fever, cough, core throat Balance issues and vertigo Buldging inflamed red tympanic membrane Middle ear effusion

Answer 278

DOESN'T REQUIRE ABX USUALLY - Seek medical help if symptoms don’t improve after 3 days Prescribe immediately if: - Symptoms last more than 4 days or not improving - Systemically unwell - Immunocompromise - Perforation and or discharge 5-7 day course of amoxicillin

Answer 279

Mastoiditis, meningitis, brain abscess, facial nerve palsy

Answer 280

Infection of the outer ear Recent swimming is a common trigger Infection: bacterial or fungal, contact dermatitis Fungal - candidias.. Especially if recurrent

Answer 281

Ear pain, itch and discharge Otoscope shows red, swollen and eczematous canal

Answer 282

Topical antibiotic or combined topical antibiotic with steroid NOTE THAT ahminoglycosides are contraindicated e.g. gentamicin If dont respond to topical ABX then refer to ENT

Answer 283

Most common cause is viral infection Most common cause of bacterial is group A strep which is treated with pen V

Answer 284

Fever during previous 24 hours P- purulence ( pus on tonsils) A- attended within 3 days of onset of symptoms I- inflamed tonsils N - no cough or coryza FeverPAIN score of 0 or 1: Do not prescribe antibiotics. FeverPAIN score of 2 or 3: Consider a delayed antibiotic prescription FeverPAIN score of 4 or 5: Consider an immediate antibiotic prescription.

Answer 285

Pen V for 10 days is first line Clarithromycin if allergic

Answer 286

Otitis media Quinsy Rheumatic fever

Answer 287

7 or more in 1 year 5 per year in 2 years 3 per year in 3 years Other indications = recurrent tonsillar abscesses, swallowing or snoring or breathing problems

Answer 288

STRAIGHT BACK TO THEATRE!

Answer 289

Peritonsillar abscess Bacterial infection with trapped pus, forming an abscess in the tonsils

Answer 290

Severe throat pain, lateralising to one side Deviation of the uvula to the unaffected side Trismus - can't open their mouth Change in voice due to pharyngeal swelling - hot potato voice Swelling and erythema

Answer 291

Streptococcus pyogens ( group A strep)

Answer 292

Needle aspiration or incision and drainage + IV abx URGENT REVIEW BY ENT SPECIALIST

Answer 293

Otitis media with effusion = middle ear full of fluid. Eustachian tube gets blocked

Answer 294

Male Siblings with glue ear Winter and spring Parental smoking

Answer 295

Peaks at 2 years of age Hearing loss = presenting feature Secondary problems e.g. speech and language delay, behavioural and balance problems Otoscopy shows dull tympanic membrane with air bubbles or fluid

Answer 296

Refer to audiometry to establish hearing loss Resolves without treatment in 3 months usually May require grommet insertion

Answer 297

Maternal rubella or CMV infection during pregnancy Genetic deafness Associated syndromes e..g Downs

Answer 298

Prematurity, hypoxia during or after birth

Answer 299

Tests hearing in all neonates

Answer 300

Younger children ( under 3) tested by looking for response to sound e.g. turning towards a sound Results are recorded on an audiogram§

Answer 301

Keisselbachs plexus ( littles area) Area of nasal mucosa in the front of the nasal cavity that contains a lot of blood vessels Unilateral bleeding

Answer 302

Sit up, tilt head forwards Squeeze the cartiliginous part of the nostrils for 10-15 minutes - if the bleeding doesn't stop after 10-15 minutes - nasal cautery, nasal packing, if failed ----> sphenopalatin ligation in theatre

Answer 303

Antiseptic, chlorhexidine, neomycin Reduces inflammation and infection Caution in peanut allergy

Answer 304

Congenital condition - split or open section of the upper lip Clift lip results from failure of the front-nasal and maxillary processes to fuse

Answer 305

Maternal anti epileptic use

Answer 306

Thyroid gland starts at the base of the tongue during foetal development Travels down neck during development to its final position in front of trachea Leaves a track called thyroglossal duct, which then disappears, but when part of it persists ---> gives rise to fluid filled cyst

Answer 307

Infection, causing a hot, tender and painful lump

Answer 308

Usually midline Moves upwards with protrusion of the tongue, as thyroglossal duct and base of the tongue are connected Mobile, non tender, soft and fluctuant

Answer 309

USS or CT can confirm the diagnosis Surgical removal

Answer 310

Congenital abnormality arising when the second branchial cleft fails to properly form during foetal development Leaves a space around by ezhithelial tissue in the left lateral aspect of the neck Presents as a soft, round, cystic swelling around the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck

Answer 311

Present as a round, soft, cystic swelling around the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck Present on infection Round, soft, non tender. Don’t transilluminate

Answer 312

Consider and exclude malignancy Referral to ENT USS Fine needle aspiration or surgery

Answer 313

Hyperactivity and inability to concentrate Affects persons ability to carry out everyday tasks, develop normal skills and perform well at school Factors should be consistent across settings

Answer 314

- Short attention span - Quickly moving from one activity - Quickly loosing interest in one task and not being able to persist - Constantly moving or fidgeting - Impulsive behaviour Disruptive or rule breaking

Answer 315

Medications - CNS stimulants E.g. methyphenidate - ritalin Dexamfetamine Atomextine

Answer 316

Fluoxetine

Answer 317

When theres an insufficient supply of glucose and glycogen stores are exhausted May happen during prolonged fasting or low card diet Liver takes fatty acids and coverts them to ketones. Ketones are water soluble. Fatty acids that can be used as fuel Ketones are buffered in normal patients dont become acidotic, but when underlying pathology e.g. T1DM causes extreme ketosis = metabolic acidosis

Answer 318

Diabetic ketoacidosis occurs in type 1 diabetes, where the person is not producing adequate insulin themselves and is not injecting adequate insulin to compensate for this. It occurs when they body does not have enough insulin to use and process glucose Ketoacidosis Dehydration - hyperglycaemia overwhelms the kidney Potassium imbalance - insulin normally drives potassium into cells, kidneys continue to balance the blood potassium so serum can be high or normal ,but total body potassium is low as theres none stored in cells

Answer 319

Dehydration + high blood sugar concentration = water moves from intracellular to extracellular space in the brain Causes brain cells to shrink and become dehydrated Rapid correction of dehydration and hyperglycaemia causes rapid shift in water from extracellular to intracellular - causes brain to become oedematous

Answer 320

Slow the IV fluids, IV mannitol and IV hypertonic saline

Answer 321

Abdominal pain Polyuria, polydipsia and dehydration Kussmaul respiration = deep breathing Acetone smelling breath

Answer 322

Hyperglycaemia Ketosis Acidosis

Answer 323

Fluid replacement ○ Isotonic saline used. Insulin ○ IV infusion started 0.1 unit/kg.hour ○ Once blood glucose is <14 mmol/l an infusion of 10% dextrose should be started at 125 ml/hr in addition to 0.9% sodium chloride ○ Long acting insulin should be continued, short acting shouild be stopped Correction of electrolyte disturbances Serum potassium often high on admission despite total body potassium being low - falls quickly following treatment = hypokalaemia. Monitor cardiac things ( add about 40 mmol to the saline if the potassium is between 3.5 -5.5 - if higher seek senior review)

Answer 324

Both the ketonaemia and acidosis should have been resolved within 24 hours If its resolved,( and patient is eating and drinking) can switch to subcutaenous insulin

Answer 325

Adrenal glands are damaged Autoimmune Reduced secretion of cortisol and aldosterone Primary adrenal insufficiency

Answer 326

Addisons TB Metastases Meningococcal septicaemia HIV APS

Answer 327

Inadequate ACTH stimulating the adrenal glands, resulting in low levels of cortisol being released Result of loss or damage to the pituitary e..g congenital underdevelopment, surgery, loss of blood flow or radiotherapy

Answer 328

Inadequate CRH release by the hypothalamus Result of patients being on long term oral steroids causing suppression of the hypothalamus When steroids are suddenly withdrawn the hypothalamus doesn't wake up quick enough and steroids are adequately produced

Answer 329

Lethargy, vomiting, anorexia, hypoglycaemia, weight loss, salt craving, jaundice, failure to thrive, abdominal pain, developmental delay Hyperpigmentation - associated with Addisons as high ACTH Vitiligo, hypoglycaemia, hyponotraemia, hyperkalaemia

Answer 330

Hydrocortisone - 20-30mg a day. Majority given in first half of day Fludrocortisone (used to replace aldosterone)

Answer 331

Glucocorticoid dose should be doubled and fludrocortisone dose stay the same With diarrhoea or vomiting, IM injected!

Answer 332

Acute presentation of severe Addisons with absence of steroid hormones Reduced consciousness Hypotension Hypoglycaemia, hyponatraemia, hyperkaelaemia

Answer 333

IV hydrocortisone 100mg IV fluids Correct the hypoglycaemia

Answer 334

Congenital deficiency of the 21 hydroxylase enzyme Causes underproduction of cortisol and aldosterone and overproduction of androgens from birth Autosomal recessive!

Answer 335

Female patients present with vitalised genitalia, enlarged clitoris due to high testosterone Hyponatreamia Hyperkalaemia Hypoglycaemia Milder cases --->females who are tall, facial hair, absent periods, deep voices and males with large penis, early puberty, deep voice and tall

Answer 336

hyperpigmentation

Answer 337

Management - Cortisol replacement - hydrocortisone - Aldosterone replacement - fludrocortisone May require corrective surgery

Answer 338

Gh produced in the anterior pituitary gland Responsible for stimulating cell production and growth of organs muscles, bones and height Stimulates release of insulin like growth factor by the liver

Answer 339

At birth: - micropenis - hypoglycaemia - serve jaundice Later - Poor growth - Short stature - Slow development of movement and strength - Delayed puberty

Answer 340

Daily subcutaneous injections of growth hormone - somatropin Treatment of other associated deficiency

Answer 341

Seeing response to medications that normally stimulate the release of GH MRI brain and genetic testing

Answer 342

When cild is born with underactive thyroid Newborn blood spot screening test Prolonged jaundice, poor feeding, constipation and reduced activity

Answer 343

Autoimmune thyroiditis ( hashimotos) anti TPO antibodies and antithyroglobulin antibodies Fatigue, poor growth, weight gain, poor school performance, dry skin, hair loss

Answer 344

TFTs Thyroid USS Levothyroxine can be used to replace thyroid hormones

Answer 345

Infants - poor feeding, vomiting and irritability Younger children - abdo pain, fever, dysuria Older children - dysuria, frequency, haematuria

Answer 346

Nitrites - gram negative bacteria break down nitrates ( normal wast product in urine) into nitrites Leukocytes - result of an infection/another cause of inflammation

Answer 347

Infants <3 months should be referred immediately to a paediatrician and started on IV ABX( ceftriaxone) Oral Abx can be considered in children over 3 months if otherwise well ○ Trimethoprim ○ Nitro ○ Cefalexin Amoxicillin

Answer 348

USS All children under 6 months with their first UTI should have an abdo USS within 6 weeks, or during the illness if there are recurreent UTIs or atypical bacteria Children with recurrent UTIs should have an abdo USS within 6 weeks Children with atypical UTIs should have an abdo USS during the ilness DMSA scan - 4-6 months post ilness to assess for damage from reucrrent or atypical UTIs VUR - Where urine has the tendency to flow from the bladder back into the ureters. This predisposes patients to developing upper UTIs and subsequent renal scarring. MCUG

Answer 349

Avoid constipation Avoid an excessively full bladder Prophylactic abx Surgical input from paediatric urology

Answer 350

* E. coli (responsible for around 80% of cases) * Proteus Pseudomonas

Answer 351

Incomplete bladder emptying * infrequent voiding * hurried micturition * obstruction by full rectum due to constipation * neuropathic bladder Vesicoureteric reflux * a developmental anomaly found in around 35% of children who present with a UTI Poor hygiene e.g. not wiping from front to back in girls

Answer 352

Inflammation and irritation of the vulvac and vagina Condition often affecting girls between ages of 3-10 years Irritation caused by sensitive and thin skin and mucosa Oestrogen helps to keep the skin and vaginal mucosa healthy and resistant to infection = much less common after puberty.

Answer 353

Soreness, itching, erythema around the labia, vaginal discharge, dysuria, constipaiton

Answer 354

Leukocytes but no nitrites

Answer 355

Management Often patients have already been treated for urinary tract infections and thrush, usually with little improvement in symptoms. It is unusual for girls to develop thrush before puberty. Generally no medical treatment is required and management focuses on simple measures to improve symptoms: Avoid washing with soap and chemicals Avoid perfumed or antiseptic products Good toilet hygiene, wipe from front to back Keeping the area dry Emollients, such as sudacrem can sooth the area Loose cotton clothing Treating constipation and worms where applicable Avoiding activities that exacerbate the problem In severe cases an experienced paediatrician may recommend oestrogen cream to improve symptoms.

Answer 356

When basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine Most common between 2 and 5 Frothy urine, generalised oedema and pallor

Answer 357

TRIAD: - Low serum albumin - High urine protein content ( >3+ protein on urine dipstick) - Oedema Other features: deranged lipid profile ( high levels of cholesterol, triglycerides and low density lipoproteins), high BP, hypercoagulability ( increased tendency to form blood clots), loss of thyroxine binding globulin lowers the total, but not free, thyroxine levels.

Answer 358

Most common = minimal change disease Secondary to intrinsic kidney disease e..g FSGS or membranoproliferazive glomerulonephritis Secondary to underlying systemic illness e..g HSP, diabetes, infection such as HIV, hepatitis and malaria

Answer 359

Small molecular weight proteins and hyaline casts on urinalysis Management = corticosteroids

Answer 360

High dose steroids - given for 4 weeks and then gradually weaned over the next 8 If steroid resistant - ACEi and immunosuppressants e.g. cyclosporine, tacrolimus or rituximab Low salt diet Diuretics may be used to treat oedema

Answer 361

- Hypovolaemia - occurs as fluid leaks from the intravascular space into the interstitial space causing oedema and low BP Thrombosis - proteins that normally prevent blood clotting are lost in the kidney, and the liver responds to low albumin by producing pro thrombotic proteins Infection - kidneys leak immunoglobulins Acute or chronic renal failure Relapse

Answer 362

Nephritis = insalmation of the kidneys Blood in urien, high bP, mild to moderate protienurea, often autoimmune diseases / infection Nephrotic syndrome = damage to glomeruli leading to protein loss, severe proteinurea, oedema, no haematuria

Answer 363

Inflammation within the nephrons of the kidney... Reduction in kidney function Haematuria: invisible or visible amounts of blood in the urine Proteinuria ( but less than in nephrotic syndrome)

Answer 364

Post streptotoccal glomeruloneprhtiis and IgA nephropathy ( Burgers )

Answer 365

- 1-3 weeks after a B haemolytic streptococcus infection such as tonsilitis caused by streptococcus pyogens - Features: headache, malaise, porteinuria, haematuria, HTN, raised anti streptolysin O titre - Immune complexes made up of streptococcal antigens, antibodies and complement proteins get stuck in the glomeruli of the kidney and cause inflammation - leads to acute deterioration in renal function causing AKI - **** THINK WITH RECENT TONSILITIS + STREPTOCOCCUS Often just supportive management, but may need antihypertensives and diuretics

Answer 366

- Bergers disease - Related to HSP and igA nephropathy - IgA depsoits in the nephrons of the kidney causes inflammation Management = supportive and immunosuppressants e.g. steroids and cyclisphosphamide. Develops 1-2 days after URTI Macroscopic haematuria

Answer 367

Thrombosis in the small vessels throughout the body, usually triggered by shiga toxins from either E coli or shigella Often affects children following an episode of gastroenteritis. Also abx and anti motility medication ( e.g. loperamide) used to treat gastroenteritis caused by E. coli 0157 or shigella increase the risk of HUS

Answer 368

- AKI - MAHA (microangiopathic haemolytic anaemia) - Thrombocytopenia - formation of blood clots consumes platelets = thrombocytopenia, blood flow through the kidney is affected by thrombi and damaged RBCs leading to AKI

Answer 369

- E coli 0157 and shigella causes gastroenteritis - Diarrhoea is the first symptom, which turns bloody within 3 days. - Around a week after the onset of diarrhoea, the features develop: ○ Fever ○ Abdo pain ○ Lethargy ○ Pallor ○ Oliguria ○ Haematuria ○ HTN ○ Bruising ○ Jaundice ( due to haemolysis) Confusion

Answer 370

Blood film is most useful initial diagnostic test Stool culture U + E - aki

Answer 371

- Supportive treatment - MEDICAL EMERGENCY = admission and supportive management with treatment of: ○ Hypovolaemia ○ HTN ○ Severe anaemia ( e.g. blood transfusions ) ○ Severe renal failure e.g. haemodialysis NO ROLE FOR ABX

Answer 372

Type of anaemia caused by destruction of red blood cells as they pass through small blood vessels ( microangiopathy) Associated with mechanical destruction of RBCs in damaged blood vessels

Answer 373

○ TTP (characterised by formation of small blood clots through the microcirculation). Get a thrombocytopenia too (low platelet count) ○ HUS ○ DIC - when widespread clotting causes RBC fragmentation. Triggered by severe infections, trauma, malignancy or pregnancy complications ○ SLE ○ Malignant hypertension ○ Pre-eclampsia and eclampsia ○ Vasculitis Bone marrow disorders

Answer 374

Involuntary urination Can be either primary = child has never achieved continence Or secondary = child has been dry for at least 6 months before

Answer 375

Most children can control daytime urination by 2 years and night time urination by 3-4 years

Answer 376

- Variation on normal development, if younger than 5 -family history - Overactive bladder - frequent small volume urination prevents the development of bladder capacity - Fluid intake prior to bedtime - Failure to wake due to deep sleep - Psychological distress Secondary causes e.g. chronic constipation, UTI, learning disability

Answer 377

MANAGEMENT: 2 week diary. Lifestyle Enuresis alarm.

Answer 378

- When previously dry for 6 months - Causes: ○ UTIs ○ Constipation ○ T1dm ○ Psychosocial MALTREATMENT - safeguarding!

Answer 379

UTI's, psychosocial problems, constipation

Answer 380

Enuresis For short term control e.g. sleepovers or na enuresis alarm hasn't been affective

Answer 381

Defect in gene located on chromosome 6 which encodes fibrocystic - responsible for creation of the tubules and maintenance of healthy epithelial tissue in kidneys, liver and pancreas

Answer 382

- Cystic enlargement of the renal collecting ducts - Oligohydramnios, pulmonary hypoplasia and potter syndrome - Congenital liver fibrosis Usually presents in antenatal period with oligohydramnios and polycystic kidneys seen on antenatal scans Oligohydramnios is lack of amniotic fluid - caused by reduced urine production by the foetus

Answer 383

Lack of amniotic fluid - Dysmorphic features e.g. Underdeveloped ear Cartlidge, low set ears, flat nasal bridge and abnormalities of the skeleton Underdeveloped fetal lungs resulting in respiratory failure shortly after brith - Large cystic kidneys ca take up so much space in abdomen that its hard for neonates to breath adequately - Renal dialysis may be needed

Answer 384

- Liver failure due to fibrosis - Portal HTN ---> oesphageal varices - Progressive renal failure - HTN due to renal failure Chronic lung disease

Answer 385

Childhood malignancy Presents under 5 years old

Answer 386

Abdominal mass Abdomianl pain Haematuria Lethargy Fever HTN Weight loss Unilateral communal Metastases found in 20% - most commonly lung

Answer 387

children with an unexplained enlarged Abdo mass - possibly Wilms tumour- arrange paediatric review within 48 hours

Answer 388

- USS of the abdomen to visualise kidneys - CT or MRI scan used to stage the tumour Biopsy to identify the histology

Answer 389

- Nephrectomy - Chemotherapy - Radiotherapy if advanced disease - Prognosis = 80% cure rate!

Answer 390

Where there is a tissue at the proximal end of the urethra that causes obstruction of urine output Occurs in new born boys Can create back pressure into the bladder, ureters and up to the kidney= hydronephrosis

Answer 391

Difficulty urinating Weak urinary system Chronic urinary retention Palpale bladder Recurrent UTIS Impaired kidney function

Answer 392

Obstruction to urine outflow in the developing foetus resulting in bilateral hydronephrosis and oligohydramnios ( low amniotic fluid volume). This leads to underdeveloped foetal lungs ( pulmonary hypoplasia) with respiratory failure shortly after birth.

Answer 393

Severe cases may be picked up on antenatal scans as oligohydramnios and hydronephrosis After birth ○ Abdominal USS - thickened, enlarged bladder + bilateral hydronephrosis ○ MCUG - shows location of the extra urethral tissue and reflux of urine back into the bladder - Cystoscopy

Answer 394

Mild cases may just be observed and monitored If required a temporary urinary catheter may be inserted to bypass the valve Ablation or removal of the extra urethral tissue during cystoscopy

Answer 395

The testes develop in the abdomen and gradually migrate down, through the inguinal canal and into the scrotum When they fail to reach the bottom of the scrotum by 3 months of age = congenital undescended testes

Answer 396

FH of undescended testes Low birth weight Small for gestational age Prematurity Maternal smoking during pregnancy

Answer 397

Watch and wait for the first 3-6 months Orchidoplexy ( surgical correction of undescended testes) Should be carried out between 6-18 months of age

Answer 398

Normal for boys that havent reached puberty for the testes to move out of the scrotum into the inguinal canal when its called or the cremasteric reflex is activated Resolves as they go through puberty and the testes settle into the scrotum

Answer 399

Congenital abnormality where the urethral meatus is abnormally displaced to the ventral side of the penis

Answer 400

Ventral urethral meatus Hooded prepuce Chordee = ventral curvature of the penis

Answer 401

Cryptoorchidism ( present in 10%) and inguinal hernia

Answer 402

Referral to urology Corrective surgery at around 12 moths of age Do NOT circumsise prior to surgery

Answer 403

Twist of the spermatic cord resulting in testicular ischaemia and necrosis Most common in males aged between 10 and 30

Answer 404

Pain is usually severe and sudden onset Pain may be referred to the lower abdomen N+V Swollen, tender testes retracted upwards Cremasteric reflex lost Elevation of the testes doesn't not ease pain (Prehn's sign) and in epidymitits it does

Answer 405

- Urgent surgical exploration - If a torted testis is identified then both should be fixed as the condition of bell clapper testis is often bilateral ○ Bell clapper = when the fixation between testicle and tunica vaginalis is absent, so the testicle hangs in a more horizontal position. Able to rotate - twisting the spermatic cord. As it rotates it twists the vessels and cuts off the blood supply USS shows whirlpool sign

Answer 406

Orchiopexy (correcting the position of the testicles and fixing them in place) Orchidectomy (removing the testicle) if the surgery is delayed or there is necrosis

Answer 407

Collection of fluid within the tunica vaginalis that surrounds the testes Tunica vaginalis = sealed pouch of membrane that surrounding the testes.

Answer 408

Communicating - Caused by patency of the processes vaginalis allowing peritoneal fluid to drain into the scrotum -Common in newborn males and usually resolves in the first few months of life Non communicating - caused by excessive fluid production within the tunica vaginalis May develop secondary to: epididymo-orchitis, torsion, testicular tumours

Answer 409

Soft, non tender, smooth swelling around one of the testes Can get above the mass on examination Transilluminates

Answer 410

Infantile will resolve within 2 years usually USS to exclude underlying cause e.g. tumour

Answer 411

Avascular necrosis of the femoral head, specifically the femoral epiphysis Occurs in children between 4-8. More common in boys!!! Idiopathic - Main complication is a soft and deformed femorla head = osteoarthritis = totoal hip replacement artificial

Answer 412

Hip pain develops progressively over a few weeks Limp Restricted hip movements Referred pain to the knee No history of trauma

Answer 413

Early changes include widening of joint space, later changes = decreased femoral head size/ flattening

Answer 414

XRAY Blood tests are normal Technetinum blood scan or MRI

Answer 415

Osteoarthritis Premature fusion of the growth plates

Answer 416

Femoral head within acetabulum = casts and braces Physiotherapy If less than 6 years - observation If older - surgical management

Answer 417

Irritable hip Caused by temporary irritation and inflammation of the synovial membrane 3-8 years old Most common cause of hip pain in children Associated with recent viral respiratory tract infection

Answer 418

- Limp/ refusal to weight bear - Groin or hip pain - Low grade fever present in minority of patients High fever should raise suspicion of other causes such as septic arthritis

Answer 419

Symptomatic management Analgesia and rest BUT make sure to both safety net and exclude other significant pathology - especially septic arthritis

Answer 420

Slipped capital femoral epiphysis OBESE BOYS 10-15 years Head of femur slips along the growth plate

Answer 421

Hip, groin, medial thigh or knee pain Loss of internal rotation of the leg in flexion Bilateral slip in 20% of cases

Answer 422

AP and lateral views on XRAY Blood tests normal

Answer 423

Internal fixation - single cannulated screw placed in the centre of the epiphysis

Answer 424

Osteoarthritis AVN of the femoral head Chondrolysis Leg length discrepancy

Answer 425

Infection of the bone Typically occurs in the metaphysis of the long bones Commonly staph aureus May be introduced directly into the bone, for example during an open fracture. Or it may have travelled to the bone through the blood - after entering the body through another route such as skin or gums

Answer 426

- Haematogenous ○ Results from bacteraemia ○ Most common form in children - Non haematogenous Results from continuous spread of infection from adjacent soft tissues to the bone or from direct injury/ trauma to the bone

Answer 427

Open bone fracture Orthopaedic surgery Immunocompromised Sickle cell anaemia HIV TB

Answer 428

Can present acutely or more chronically refusing to use the limb or weight bear Pain Swelling Tenderness

Answer 429

Staph aureus most common In sickle cell patients though- salmonella is more common

Answer 430

MRI Blood tests show raised inflammatory markers and WBCs in response to infection

Answer 431

Flucloxacillin Clindamycin if penicillin allergic

Answer 432

Type of bone cancer Usually presents in adolescents and younger adults aged 10-20 Most common bone to be affected is the femur

Answer 433

Persistent bone pain Worse at night time May disturb them of wake them from sleep Other symptoms = bone swelling, palpable mass, restricted joint movements

Answer 434

- Urgent direct access XRAY within 48 hours for children presenting with unexplained boen pain or swelling - If it suggests a possible sarcoma, they need an urgent specialist assessment within 48 hours - Raised ALP

Answer 435

Poorly defined lesion in the bone Destruction of the normal bone and a fluffy appearance Periosteal reaction = irritation of the lining of the bone - described as a sun burst appearance

Answer 436

Resection of the lesion Adjuvant chemotherapy used alongside

Answer 437

Structural abnormality in the hips caused by abnormal development of the foetal bones during pregnancy Leads to instability in the hips and tendency or potential for subluxation or dislocation Potential to persist into adulthood, leading the weakness, recurrent subluxation or dislocation, abnormal gait and early degenerative changes

Answer 438

During new born examinations or later when the child presents with hip asymmetry, reduced range of movement in the hip or a limp

Answer 439

Female Breech presentation Positive family history Birth weight >5kg Oligohydramnios

Answer 440

DDH is screened for on neonatal examination at birth and 6-8 weeks USS for infants with: - First degree family history or hip problems in early life - Breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery - Multiple pregnancy - All infants screened at both the newborn check and also 6 week baby check using Barlow and Ortolanti tests

Answer 441

Barlow - attempts to dislocate an articulated femoral head Orlanti - attempts to relocate a dislocated femoral head

Answer 442

USS BUT If >4.5 months then XRAY is first line

Answer 443

Most unstable hips will spontaneously stabilise by 3-6 weeks of age Palvik harness if baby presents at less than 6 months Older children may require surgery

Answer 444

Inadequately mineralised bone in developing and growing bones Results in soft and easily deformed bones Osteomalacia in adults

Answer 445

Deficiency in calcium or vitamin D - vitamin D is produced by the body in response to sunlight or obtained through diet - Calcium found in dairy/ green vegetables - Rare form caused by genetic defects that result in low phosphate in the blood --hereditary hypophosphatemia rickets - X linked dominant

Answer 446

- Lethargy - Aching bones and joints - Swollen wrists - Bone deformity - Poor growth - Dental problems - Muscle weakness - Bowing legs, knock knees - Rickety rosary - ends of the ribs expand at the costochondral junctions - Craniotabes - soft skull, with delayed closure of the sutures and frontal bossing Delayed teeth with under development of the enamel

Answer 447

Reduced Serum vitamin D Reduced serum calcium Raised ALP PTH high

Answer 448

Prevention is key Breastfeeding women should take vitamin D supplement Vitamin D oral - ergocalicefrol

Answer 449

Autosomal dominant disorder associated with dwarfism. Abnormal cartilage Achondroplasia gene, FGFR3 is on chromosome 4. Mutation in this gene

Answer 450

Disproportionate short stature. Average height around 4 feet. Limbs mostly affected by reduced bone length The femur and humerus- Proximal limbs- more affected than bones of the forearm and lower leg Normal trunk Short digits Bow legs Disproportionate skull

Answer 451

Recurrent otitis media due to cranial abnormalities Kyphoscoliosis Spinal stenosis OSA Obesity Foramen magnum stenosis can lead to cervical cord compression and hydrocephalus

Answer 452

MDT involvement Leg lengthening surgery can add height

Answer 453

Inflammation at the tibial tuberosity where the patella ligament inserts Common cause of anterior knee pain in adolescents Typically occurs in patients aged 10-15 years and more common in males usually unilateral but can be bilateral

Answer 454

Palpable hard or visible tender lump at the tibial tuberosity Pain in the anterior aspect of the knee Pain exacerbated by physical activity, kneeling and on extension of the knee

Answer 455

Focuses on reducing pain and inflammation Reduction in physical activity Ice NSAIDs for symptomatic relief

Answer 456

Genetic condition where you get brittle bones that are prone to fractures Collagen metabolism Autosomal dominant

Answer 457

Hypermobility Blue/grey sclera Triangular face Short stature Deafness from early adulthood Dental problem Bone deformities and joint pain

Answer 458

Investigations - Adjusted calcium, phosphate, PTH, alp are usually NORMAL Management - XRAYs for diagnosing fractures - Bisphosphates to increase bone density - Vitamin D supplementation to prevent deficiency MDT

Answer 459

Single painful joint: - Hot, red, swollen, painful - Refusing to weight bear - Stiffness and reduced range of motion - Systemic symptoms e.g. fever, lethargy and sepsis - Can be subtle in young children

Answer 460

Kocher criteria Fever >38.5 degrees Non weight bearing Raised ESR Raised WCC

Answer 461

Investigations - Joint aspiration for culture - will show raised WBC - Raised inflammatory markers - Blood culture's SEPSIS 6! May drain.

Answer 462

Type 1 - Straight across Type 2 - Above Type 3 - BeLow Type 4 - Through Type 5 - CRush

Answer 463

Pain management - Paracetamol Morphine do not give codeine, tramadol or aspirin in fractures - risk of Reyes

Answer 464

Septic arthritis Developmental dysplasia of the hip Transient sinovitis

Answer 465

Septic arthritis Transient sinovitis Perthes disease

Answer 466

Septic arthritis Slipped upper femoral epiphysis Juvenile idiopathic arthritis

Answer 467

child under 3 years Fever Waking at night with pain Weight loss Anorexia Night sweats Fatigue Persistent pain Stiffness in the morning Swollen or red joint

Paediatrics Flashcards

(495 cards)