Paediatrics 2 Flashcards

Question

Duchennes muscular dystrophy

Answer 1

- X-linked recessive condition > gradual, progressive weakening and wasting of muscles - Gower's sign - due to proximal muscle weakness - Defective gene for dystrophin on X-chromosome. Mother carrier = 50% chance daughters carriers, 50% chance sons have condition - Presentation 3 - 5yo, pelvic weakness, eventually wheelbound by teens, life expectance 25 - 35yo if managed well - Oral steroids slow progression by 2 years - Creatine supplements slightly improve muscle strength

Answer 2

Physical harm in a child deliberately inflicted or failure of caregiver to prevent harm Key features to look out for: - History - Delayed presentation - Inconsistencies in caregiver narrative - Injuries/fractures of varying ages - Subconjunctival/retinal haemorrhage - Burns, scalds, torn frenum (head injury/force-feeding), FGM

Answer 3

- Detailed history, body map - Radiology: skeletal survey: rib, finger, clavicle fractures, metsphyseal corner fractures (twisting/pulling of limb) - Lab tests: for ddx e.g. leukaemia, immune thrombocytopenic purpura - Mx see safeguarding section in paeds 1

Answer 4

- Most common nutritional disorder in high-income countries - In children, age- and sex-matched BMI centiles are used - Overweight > 91st centile, obese > 98th centile - Increasing problem due to obesogenic environment, more energy-dense foods, reduced physical activity, more screen time - RF: low socioeconomic status Prevention: reduce screen time, increase education + physical activity

Answer 5

- Most in primary care - Heathier eating - regular meals, eating together, nutrient-rich foods, vegs + fruits, small portion sizes, invovling whole family - Increase physical activity e.g. walking to school, football, swimming - Limit screen time < 2 hr a day - Children > 12 with BMI > 35 + complications or > 40: Orlistat (reduces dietary fat absorption), bariatric surgery in rare cases

Answer 6

- Slipped upper femoral epiphysis - Idiopathic intracranical hypertension - Hypoventilation syndrome - Non-alcoholic fatty liver disease - Gallstones - PCOS - Type 2 diabetes - Asthma - Low self-esteem, teasing, depression

Answer 7

- Adenotonsillar hypertrophy or Down's syndrome - Features: excessive daytime sleepiness, learning/behaviour problems, faltering growth, severe = pulmonary HTN - Ix: sleep studies: overnight pulse oximetry at home to full measurement in lab, normal ≠ exclusion - Mx: adenotonsillectomy, nasal or face CPAP masks to maintain upper airway overnight

Answer 8

- H. pylori = risk factor for duodenal ulcers, consider if child has epigastric pain, especially if night-waking, radiation to back or FHx of peptic ulcer - H. pylori > nodular antral gastritis > abdo pain and nausea - Ix: urea breath test (HP make urease), stool antigen test Mx: - Peptic ulcer, H. pylori +ve: triple therapy with PPI, amoxicilin AND metronidazole/clarithromycin) - If ineffective = upper GI endoscopy

Answer 9

- Emergency admission! - Proptosis (bulging eyeballs), painful or limited ocular movement +/- reduced visual acuity - Ix: FBC (raised WBC, inflammatory markers), blood cultures, CT/MRI to assess for posterior spread of infection - IV abx (IV co-amoxiclav for cellulitis near eyes (NICE) - Surgical drainage if abscess - Staphylococcus aureus most common

Answer 10

Medical term for a widespread rash that is usually accompanied by systemic symptoms such as fever, malaise and headache. Usually caused by a infection, and is either a reaction to toxin produced or damage to skin by the infective organism or immune response

Answer 11

Exanthems during children are very common and usually due to specific viral infections e.g.: - Chickenpox (varicella) - Measles (morbillivirus) - Rubella (rubella virus) - Non-specific viral Bacterial exanthem: - Staphylococcal toxin: toxic shock syndrome - Streptococcal toxin infection: scarlet fever

Answer 12

- Non-specific exanthems appear as spots or blotches with or without itch - Usually more extensive on trunk than extremities - Most cases, patients might have the following symptoms prior to rash: fever, malaise, headache, loss of appetite, muscular aches and pains

Answer 13

Diagnosis by distinct patterns and prodromal (pre-rash) symptoms which allow for clinical diagnosis If required, consider viral swab for culture and PCR, blood test for serology or PCR

Answer 14

Symptomatic: - Paracetamol to reduce fever - Moisturising emollients to reduce itch

Answer 15

Prodrome of persistent high fever (> 39) for at least 5 days Widespread erythematous maculopapular rash and desquamation (peeling) on palms and soles - Strawberry tongue (red tongue with large papillae - Cracked lips - Cervical lymphadenopathy - Conjunctivitis

Answer 16

Systemic symptoms (fever, headache, cough, diarrhoea and vomiting) and few or many pruritic papules that progress to vesicles and crusted lesions that might scar Mainly on face and trunk

Answer 17

- Prodrome of fever, malaise, anorexia, then conjunctivitis, cough and coryza - Then Kolpik spots (oral papules) appear 2 - 3 days into prodrome period - 24 to 48 hours later, rash starts on cheeks and spreads to trunk and limbs within a day or two - Widespread "morbiliform" erythema (5 - 10mm macules), fades in a few days, might scar | https://dermnetnz.org/topics/measles-images

Answer 18

- Prodrome can be asymptomatic or with slight fever, sore throat, rhinitis and malaise - Can take 2 - 3 weeks for rash to appear - Infectious from 1 week before the symptoms start and for 5 days after the rash first appears. - Pale pink erythematous rash that starts on the face and spreads to neck, trunk and extremities, lasts up to 5 days

Answer 19

Inflammation of the tonsils Most common is viral infection If bacterial - most common cause is group A streptococcus (S. pyogenes)

Answer 20

- Sore throat - Fever (> 38) - Pain on swallowing Examination of the throat = red, inflamed and enlarged tonsils with/without exudates - small, white patches of pus on the tonsils

Answer 21

Estimates the probability that tonsillitis is due to bacterial infection and benefit from antibiotics score ≥ 3 = 40 - 60% possibility of bacterial tonsillitis and abx offered: 1 point for each: - Fever over 38ºC - Tonsillar exudates - Absence of cough - Tender anterior cervical lymph nodes (lymphadenopathy)

Answer 22

Alternative to Centor score Score 2 - 3 = 34 - 40% probability Score 4 - 5 = 62 - 65% probability of bacterial tonsillitis - Fever during previous 24 hours - P – Purulence (pus on tonsils) - A – Attended within 3 days of the onset of symptoms - I – Inflamed tonsils (severely inflamed) - N – No cough or coryza

Answer 23

- Consider admission if patient is immunocompromised, systemically unwell, dehydrated, has stridor, respiratory distress or peritonsillar abscess (quinsy) or cellulitis. - Calculate Centor or feverPAIN score - If viral: educate patients and give safety net advice - Simple analgesia with paracetamol and ibuprofen - Advise return if pain does not settle after 3 days or fever > 38.3 - consider antibiotics or alternative diagnosis - Antibiotics if the Centor score is ≥ 3, or the FeverPAIN score is ≥ 4. - Phenoxymethypenicillin, clarithromycin - Also, consider antibiotics if young infants, immunocompromised patients or significant co-morbidity - Delayed prescription - if symptoms worsen or do not improve in next 2 - 3 days

Answer 24

- Irritable hip, transient irriation and inflammation in synovial membrane of the joint, preceding viral URTI - No fever, if fever consider SEPTIC Featurees: limp, refusal to weight bear, groin/hip pain, low grade temp, otherwise well Mx: simple analgesia, clear safety netting if worsens or develop fever! FU at 48hrs and 1 - 2 week, as should improve and resolve respectively

Answer 25

- Synovitis due to infective trigger. - Usually < 6 weeks of joint swelling, commonly knees, ankles - Triad of conjunctivitis, urethritis, arthritis (can't see, pee, climb a tree) Causes: - Gastroenteritis: salmonella, shigella, campylobacter - STI: chlamydia, gonococcus Mx: - Exclude septic arthritis - Joint aspirate for MC+S - Tx cause - NSAIDs - Intraarticular steroids - Sufasalazine/methotrexate if persistent

Answer 26

- Serious infection of joint space > bone destruction - Most common < 2yo - Cause: Staphylococcus aureus, gonococcus (sexually active) - RFs: immunodefiency, sickle cell disease Spread: haematogenous spread, punture wound, infected skin lesions e.g. chickenpox

Answer 27

- Erythematous, warm, acutely tender joint, reduced ROM - Acutely unwell, febrile child - Limb held still (pseudoparalysis) - Sometimes accompanies osteomyelitis (joint effusion + marked tenderness over bone)

Answer 28

- Follow local hot joint policy - Diagnostic: urgent joint aspiration guided by USS for gram staining, microscopy, culture and abx sensitivities - Empirical IV abx until sensitivities known, continued for 3 - 6 weeks - Surgical drainage + washout if abx ineffective or deep-seated (e.g. hip)

Answer 29

Coping technique for negative emotions, commmunicate distress, to punishing themselves Risk factors: female (x4), depression/severe anxiety, previous hx, living in care, abusive home life - Cutting, burning, biting, bruising, ligatures, wall punching (boxers fracture), overdose Sensitive hx and examination important

Answer 30

- Alone, with parents = non-disclosure - Safe environment - Enough time - Clear rules about confidentiality - Validating distress - Assurance about support - Direct but senesitive questions - Normalisation "sometimes if people feel stressed, worried or low, they can have thoughts about harmimg themselves, has this happened to you?"

Answer 31

Some adolescents will experiment with drugs, some become habitual users for rec use or to avoid unpleasant memories A small number = psychologically or physically dependent Alcohol, cannsbis = most common Solvents, LSD, ecstasy, amphetamine Coacine + heroin = most addictive

Answer 32

- Intoxication - Unexplained absence from home/school - Mixing with known users - Spending or stealing a lot of money - Drug equipment - Medical complications resulting from use

Answer 33

- Often concerned parent presents to doctor - Interview, urine sample for drug screen - Referral or self-referral to local drugs/alcohol services - Explain helath risk to adolescent - Medical invovlement usually focused on psychopathology or physical complications:

Answer 34

- Become popular in recent years = more common in clinics + exams - MOA: blocks uptake of dopamine, noradrenaline and serotonin - CV: coronary artery spasm > MI, HTN - Neuro: seizure, mydriasis, hypertonia/reflexia - Psych: agiation, psychosis, hallucinations

Answer 35

- 1st line is benzodiazepines - Chest pain: benzo + glyceryl trinitrate - MI = percutaneous coronary intervention

Answer 36

Causes serotonin release and catecholamines Clinical features: - Neuro: agitation, anxiety, confusion, ataxia - CV: tachy, HTN - Muscle rigdity - Hyponatraemia (SIADH) - Hyperthermia - Rhabdomyolysis Mx: supportive with IV fluids, sedation with benzodiazepines

Answer 37

Features: - Early: abdo pain, vomiting - Later (12 - 24h): liver failure - Toxic metabolite (NAPQI) due to saturation of liver metabolism - Determine risk by measuring plasma paracetamol conc.

Answer 38

- Present < 1hr = activated charcoal N-acetylcysteine if: - Plasma conc on or above tx line at 4hrs (100mg/L) and 15hrs (15mg/L) - Staggered OD - Present > 8 - 24hrs OD of > 150mg/kg - Present > 24hrs OD if jaundiced, hepatic tenderness, ALT > upper normal limit - IV acetylcysteine, 12 hr SNAP regime (100mg/kg over 2 hours then 200mg/kg over 10 hours)

Answer 39

- Tearing of bridging veins as they cross subdural space - Characteristic in non-accidental injury by shaking/direct truma in infants and toddlers - Shaking = retinal haemorrhages 1st line Ix: - CT = crescent-shaped collection, not limited by suture lines (hyperdense/bright if acute, hypodense/dark if chronic) Mx: - Small + no neuro deficits = conservative - Neuro deficits = surgical decompression with burr holes

Answer 40

- More common in adults - Causes: trauma, aneurysm - Presents with thunderclap headache (severe, rapid onset) - Vomiting, confusion or reduced consciousness, meningism (photophobia, neck stiffness) seizure, coma

Answer 41

- 1st line: non-contrast CT = blood in CSF (bright/hyperdense) Lumber puncture (LP) if: - CT >6h after symptoms and normal - > 12h after symptoms to allow xanthochromia Mx: - Oral nimodipine (stop vasospasm) - Neurosurgery or interventional radiology - Aneurysm: supportive, bed rest, analgesia, VTE prophylaxis

Answer 42

- Check if responsive - Shout for help - Open airways - Look, listen + feel for breathing - 5 rescue breaths - Check circulation: inflants = brachial/femoral pulise, children = femoral - 15 chest compressions: 2 rescue breaths (lay person = 30:2) - 100-120/min - Compress lower half of sternum, 1/3 depth of chest - Infants: two-thumbs

Answer 43

Invovles mucosa of nasal cavity, sinuses, nasopharynx, oropharynx and larynx Most common causes - rhinovirus and coronavirus, respiratory syncytial virus 5 - 6 infections a year in children Clinical features: coyza (nasal discharge, obstruction, sore throat, cough), headache, tiredness, generally unwell Examination: throat, ears, cervical lymph nodes, chest, hydration status, HR, RR, temp, O2 sats, if deranged, consider other causes ## Footnote Useful "Traffic light system" for identifying risk of serious illness in < 5s: https://www.nice.org.uk/guidance/ng143/resources/support-for-education-and-learning-educational-resource-traffic-light-table-pdf-6960664333

Answer 44

- Usually self-limiting , so supportive with paracetamol, rest, fluids - Uncomplicated = resolve within 7 - 10 days - Complications: viral wheeze, bronchiolitis and croup (admission for supportive mx might be required)

Answer 45

- Generalised/localised superfical skin swelling - Pale, pruritic, pink raised skin "hives" - Erythema might not be so obvious on darker skin - Common cause = allergy, viral, drug reaction Mx - Non-sedating antihistamine e.g. loratadine, cetirizine - Sedating antihistamine e.g. chlorpheamine for sleep

Answer 46

- Astrocytoma (~40%) - Varies from benign to highly malignant (glioblastoma multiforme) - Mostly primary unlike in adults

Answer 47

Malignancy arising from astrocytes, cells that support the nerve cells in the brain - Raised ICP = headache and behavioural changes - Seizures - Persistent or recurrent vomiting - Problems with balance, coordination or walking - Abnormal eye movements

Answer 48

- MRI - Lumbar puncture for staging, seek neurology advice if rasised ICP

Answer 49

1st line: surgery for hydrocephalus, tissue diagnosis and resection of tumour Radiotherapy after surgery for malignant CNS tumours

Answer 50

Tumour arising from neural crest tissue in adrenal medulla and sympathetic nervous system - Usually < 5yo - Good prognosis, 80% cure rate

Answer 51

- Abdo mass usually adrenal in origin, but can be anywere along sympathetic chain from neck to pelvis - Pallor - Weight loss - Hepatomegaly - Bone pain - Limp

Answer 52

- Urinary catecholamine (e.g. adrenaline) - Biopsy - Bone marrow biopsy Management - Surgery, curative if local - Chemo, radiotherapy and surgery in metastatic disease (poor prognosis)

Answer 53

Most common renal malignancy in children, usually < 5 yo Often incidential finding as abdo mass Clinical features - Asymptomatic - Abdo pain - Haematuria - Lethargy - Fever - Hypertension - WEight loss

Answer 54

Diagnosis: - Abdo ultrasound - CT staging - Biopsy to confirm dx Management: - Surgical excision and removal of affected kidney (radical nepphrectomy)

Paediatrics 2 Flashcards

(78 cards)