1
Q
Main things covered in hx?
A
hild’s age, nature of the problem and observation
2
Q
HPC for hx?
A
parent/child accounts; ADLs affected and how parents taken action; why referred and parent worries; to check – general health, normal growth, E+D and behaviour change; wet/dirty nappies
3
Q
PMH for hx?
A
maternal obstetric complications; birthweight; perinatal problems (jaundice, fits, fever, bleeding, feeding); immunisations and past illnesses; medication, alcohol, drugs
4
Q
SH for hx?
A
family (normal SH that you would take but for family members); child happy at home/school; impact of illness on carers and benefits, same father of kids; siblings; play, eating, sleeping, pets; who looks after child; hopes, fears, expectations of parents for child in hospital
5
Q
Development covered in paeds overview?
A
parental concerns, developmental milestones, previous child health surveillance checks, enuresis, child behaviour, sleeping problems, progress at school; use ABCD for consciousness if needed; faltering growth = red flag; plot weight, height and head circumference for infants on chart
6
Q
How to stage puberty?
A
Tanner staging
7
Q
Define low birthweight?
A
under 2500g, very low = under 1500g and extremely low is under 1000g
8
Q
What is small for gestational age?
A
low weight under 10th percentile for age
9
Q
2 types of IUGR?
A
symmetrical = fetus affected from early pregnancy; asymmetrical = foetus affected later e.g. pre-eclampsia; most catch up to height/weight in 2 years but adults slightly shorter; coronary HD and obesity
10
Q
Behavioural problems in kids?
A
food refusals, overeating (comfort), pica (eating things which aren’t food)
11
Q
Causes of prematurity?
A
smoking, poverty, malnutrition, PMH, GU infection, chorioamnionitis, pre-eclampsia, DM, polyhydramnios, closely spaced pregnancies, multiple, uterine, malformations, placenta praevia (placenta covers cervix causing bleeding during pregnancy), abruption, premature membrane rupture
12
Q
S+Ss mastitis?
A
tender, hot reddened area of breast with/out fever; can’t breastfeed
13
Q
Ages for normal pulses?
A
110-160 <1; 95-150 2-5; 80-120 5-12
14
Q
Causes of HT in children?
A
renal parenchymal disease or essential mainly; same treatment as adults but only if symptomatic
15
Q
Problems from HT crisis and treatment in children?
A
cerebral oedema, HF, seizures, pulmonary oedema, renal failure; use nifedipine, labetol or sodium nitroprusside
16
Q
S+Ss HF in children?
A
poor feeding, sweating, tachypnoea, tachycardia, gallop rhythm, cardio/hepatomegaly
17
Q
Describing HS in children?
A
describe timing, duration, loudness, radiation and site of max intensity; 3rd HS is normal
18
Q
Signs for severely ill children (GRUNTING)?
A
Grunting, weak/continuous high-pitched cry, tachypnoea; Rib recession, nasal flaring, sternocleidomastoid retraction, stridor; Unequal/unresponsive pupils, hypotonia, focal CN; Not using limbs/lying still, odd posture, decerebrate (arms and legs extended); Temp >38 (6 months) or 39; I have a bad feeling (judgement); Neck rigidity, non-blanching rash, meningism; Green bile in vomit
19
Q
4 fields considered during normal child development?
A
gross motor, vision/fine motor, hearing/speech/language and social/emotional/behavioural
20
Q
Advice for parents with crying babies?
A
peaks at 6-8 wks and subsides by 4 months; support parents so preventing post-natal blues, reduce their stress (take it in turns); teach that this normal and say techniques to deal (rocking, singing, hungry or tired, hugging); colic (paroxysmal crying with legs up – hunger)
21
Q
What are the median and limit ages for milestones in development?
A
- Take into account median age (MA) for each milestone
* Limit ages (LA) – when child should have reached milestone
22
Q
List main child development milestones in the first 5 years?
A
o Unsupported walking – 12 months, 18 months (later more likely to be hypermobile)
o Sat up – 6 months
o Crawling – 8-9 months (bottom shufflers later)
o Motor development follows CNS development
o 3-4 word sentences – 2.5-3
o Interactive play – 2.5-3
o Drink from cup – 12 months
o Vision/fine motor >1
o Hearing/speech/language from 18 months
o Social from 2.5
o Respond to name and familiar words – 12 months
o Orthoptist screening age 5
23
Q
When is developmental correction intervention needed?
A
• Correction not required til after 2 (cognitive problems appear later than developmental)
24
Q
Tests for development in child assessment?
A
Denver developmental screening test; Griffiths and Bailey developmental scales; IQ tests; cultural backgrounds (for cognitive); parents’ evaluation of developmental status; ages and stages questionnaire; Brigance screens II, modified checklist for autism in toddlers
25
How to assess hearing in newborns?
optoacoustic emission or auditory brainstem response audiometry
26
What is amblyopia?
cataract interfering with optic pathway development
27
Define delay with respect to development?
slow acquisition of all skills in a field
28
Define disorder with respect to development?
maldevelopment of a skill
29
Define impairment with respect to development?
loss/abnormality of a function
30
Failure to thrive definition and tests?
poor weight gain in infancy; MSU, coeliac serology, U+E, glucose, LFT, calcium, igs, CRP, TSH, FBC, sweat, urinary aas, stools, CXR, US renal/CNS
31
Failure to thrive short stature definition and causes?
height <3rd percentile; hypopituitarism, low GH (arginine stimulation test – use somatotrophin to treat)
32
Causes of tallness?
thyrotoxic, precocious puberty, Marfan’s, homocystinuria
33
Causes of abnormal heaviness?
snacks, low exercise, hypothyroidism, Cushing’s, Prader-Willi, Bardet-Biedl, Cohen syndrome, polycystic ovary syndrome
34
Abnormal motor signs in children?
head control, rolling, sitting, walking balance, gait, involuntary movements
35
Causes of developmental delay in children?
central motor deficit, congenital myopathy, spinal cord lesions, global developmental delay
36
Define cerebral palsy?
oo Permanent disorder of movement, posture or motor function from non-progressive abnormality in brain development under the age of 2
37
What is affected in cerebral palsy?
cognition, communication, vision, perception, sensitisation, behaviour, seizure and secondary MSK problems; abnormal posture, feeding difficulties, gait, asymmetrical head function
38
What are the causes of cerebral palsy?
80% antenatal = CV haemorrhage, structural maldevelopment, TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex); intra-partum = hypoxic-ischaemic brain injury; postnatal = meningitis, head trauma, hypoglycaemia, hydrocephalus, hyperbilirubinaemia
39
Diagnosis for cerebral palsy?
clinical exam; posture, tone, hand function and gait; infection screen; CT/MRI head; EEG/NCS; TFTs, FBC, U+Es, bone chemistry, blood gases
40
Spastic changes in cerebral palsy?
UMN damage; unilateral limbs only (facial sparing); 4-12 months = fisting of hand affected, flexed arm, hand function, toe pointing when lifted, extensor posturing, poor head control, low central tone, seizures, microcephaly
41
Dyskinetic changes in cerebral palsy?
involuntary, uncontrolled, stereotyped movements; more evident with movement/stress; chorea, athetosis (slow writhing movements) and dystonia; intellect can be unimpaired; floppiness; signs from basal ganglia damage; hypoxic-ischaemic encephalopathy (brain damage after hypoxic-ischaemic event, resp depression at birth, low pH
42
Treatment for dyskinesia in cerebral palsy?
resus, avoid hyperthermia, exclude other causes, treat seizures)
43
Ataxic changes in cerebral palsy?
genetic; trunk and limb hypotonia, poor balance and delayed motor development
44
Treatment for ataxia in cerebral palsy?
botox, intrathecal baclofen and DBS (for hypotonia)
45
Examples of speech and language delay?
hearing loss, global developmental delay, anatomical deficit, environmental deprivation and familial pattern; disorders of expression, comprehension, speech intelligibility, pragmatics and social skills; hearing tests and SALT; symbolic toy test and Reynell test
46
S+Ss of dyspraxia?
disorder of motor planning; no findings on neuro exam; features like handwriting, dressing, literacy, copying, drawing, messy eating
47
Types of hearing impairment in children?
sensorineural presents soon after birth and irreversible; microtia (undeveloped external ear) and meatal atresia can be helped with bone conduction hearing aids; conductive hearing loss from middle ear mild-moderate (chronic otitis media); Down’s, cleft palate, atopy prone to middle ear loss
48
Management of hearing impairment in children?
impedence audiometry tests (pressure in middle ear) determine functioning; long term abx or decongestants; grommets sometimes
49
S+Ss visual impairment?
ocular malformations; not smiling responsively by 6 weeks, poor visual response, nystagmus, squint
50
Causes of visual impairment?
retinoblastoma = life threatening; squint = retinal reflexes checked (corneal light reflex test and cover test) and over 3 months refer to ophthalmologists (commonly refractive error but can be retinoblastoma); paralytic = rare, concomitant (common); corneal light reflex test and cover test; hypermetropia = most common refractive error (long-sigthedness); myopia (near-sightedness) in adolescence; astigmatism common; patch good eye to improve bad eye
51
Sick children treated at home and conservatively?
• Usually mild and can be treated at home; hosp admission rate increased = lower threshold, lack of instant test to rule out serious illness, repeated admission for children with complex illnesses; parents can stay overnight with them; consider psychosocial factors if treated at home
52
Treatment of general pain in children?
observation and parent input; distractions used and topical anaesthetics; use NO, mild sedatives or hypnotics, opioids and post-op analgesics; nerve-blocks used; IM drug injections should be avoided; aspirin not given under 16 as Reye syndrome (encephalopathy and liver failure); OD high from longer half-life and low renal excretion
53
Normal resp rate in kids?
30-40 in infants, 25-35 in young children and 20-25 in older children
54
Normal bp in kids?
80-90 in infants, 85-100 in young children and 90-110 in older children
55
Exam in those with resp/neuro/circ failure?
look for history, O/E, trauma, rash, smell, scars and medicalert bracelets; more likely to resp/hypoxia than cardiac failure; disinterested and not alert
56
Treatment for shockable VF/VT?
after 3rd shock give adrenaline and amiodarone
57
Causes of resp failure?
lungs can’t give good gas exchange; causes = alveolar hypoventilation, v/q ventilation, diffusion impairment and intrapulmonary shunting; less than 92% O2 sats give O2
58
Treatment for resp failure?
can give CPAP or biphasic positive airways pressure; intubation for = progressive hypoxaemia, reduced consciousness, progressive neuromuscular weakening, tiring
59
S+Ss resp failure?
tachycardia, resp>50, nasal flaring, accessory muscle use, head retraction cyanosis, unable to feed, tired and sats <92%
60
Why low fluid in kids and compensated and decompensated shock?
higher BMR means need more fluids; lose from = no oral, fever, diarrhoea, burns, capillary leak; dehydration shock = metabolic acidosis, low BP; compensated shock = tachycardia, tachypnoea, low skin turgor, delayed cap refill, pale and mottled skin; decompensated = acidotic breathing, bradycardia, confusion, blue peripheries, no urine output, hypotension
61
Treatment for compensated/decompensated shock?
PICU if IV fluids not helping; can have renal support and inotropic support
62
Problems and treatment for septic shock?
fluid maldistribution with cap leak; may need central venous monitoring and catheterisation; clotting derangements, pulmonary oedema, DIC, myocardial dysfunction, tilt head 20-30 seconds to reduce ICP risk and mannitol, early abx
63
Risks in babies emergency medicine?
gestation <32 weeks, duration >1 minute, repeat event, CPR, concerning history, abnormal O/E, SIDS = 2-4 months (unexpected cot death;
64
Tests for babies in emergency care?
obs, ECG, swab for pertussis, sats
65
Prevention of SIDS?
sleep supine, stop overheating [16-20 degrees in room] and no smoking, use a grow bag so baby can’t move, not too much bedding; baby must have a post-mortem; CONI programme, grief counselling for parents
66
What is involved in children coma scale?
motor = 6carrying out request, 5localised pain response, 4withdraw to pain, 3flexor pain response, 2extensor posturing to pain, 1no response; verbal = 5orientated, 4crying but consolable, 3inconsistently inconsolable, 2inconsolable crying, 1no response; eye opening = 4spontaneous, 3from speech, 2to pain, 1none
67
Treatment and management of traumatic accidents?
always try to maintain brain blood supply if head injury and evacuate haemorrhage (otherwise get brain injury); liver and spleen rupture apparent immediately; pneumothorax and haemopericardium from blunt trauma; ECG for electrical burns and do burn size and depth (fluids if >10% body size)
68
Causes of poisonings?
accidental, iatrogenic, deliberate or intentional
69
Prevention of poisonings?
child resistant containers, low packet number of analgesia
70
S+Ss poisoning?
behavioural changes, hyperactivity, developmental delay, chronic lead nephropathy, abdo pain, headache, lethargy, vomiting, seizures
71
Poisoning treatment?
chelation effective; activated charcoal (not for iron and pesticides); Iv acetylcysteine for paracetamol; Iv desferrioxamine for iron (gives red-orange urine); intubation if low GCS; supportive management; haemodialysis for salicylates; TCAs for sodium bicarb and ventilation; blood glucose and ventilate for alcohol; IV desferoxamine for iron; atropine and pralidoxime for pesticides
72
Specific antidotes for poisons?
beta-blockers = atropine (bradycardia) with glucagon and sometimes adrenaline/dopamine; CO = high flow O2, mannitol for cerebral oedema; digoxin = atropine, digoxin specific antibody; opioids = IV naxolone; methanol/ethylene glycol = fomepizole; sulfonylureas = octreotide
73
Child abuse categories?
physical, emotional, sexual, neglect and fabricated illness (suffocate, give poisons, OD); witnessing intimate partner violence and FGM serious
74
Define neglect?
persistent failure to meet child’s physical and psychological needs
75
Risks for child neglect?
failure to meet parent’s expectations, born after forced sex, mental health problems, substance misuse, step-parents, domestic violence, closely spaced births, social isolation and poverty, disability
76
Factors to consider in child protection?
age, hx from child, plausibility of injury, background, injury reporting delay, inappropriate reaction of caregiver
77
Examples of neglect?
child miss appts, lack of immunisations, dirty, hungry, inadequate clothes, substance misuse, caregiver indifferent to child, child ‘wrong-gender’, partner separation, babies non-demanding, toddlers fearful/violent, school children violent/wetting/antisocial, adolescents self-harm
78
Sexual abuse examples?
porno, pregnant, STI, vaginal bleeding, itching, discharge, rectal bleeding, sexual acting out, self-harm, aggression, poor school performance; need to exclude other causes; can swab for perp or full radio skeleton under 30 months
79
Management for abuse?
does child need immediate protection; safety of other siblings; hosp or foster care; social workers
80
What is trisomy 18?
Edward's syndrome
81
Edward's syndrome S+Ss?
(small and bad heart and kidneys); low birth weight, prominent occiput, small mouth and chin, short sternum, flexed overlapping fingers, cardiac/renal malformations
82
What is trisomy 13?
Patau syndrome
83
Patau syndrome S+Ss?
(wrong with head, face, heart and kidneys), structural brain defects, scalp defects, small eyes, cleft palate, polydactyly and cardiac/renal malformations; amniocentesis and chromosomal analysis
84
S+Ss turner syndrome?
45X; early miscarriage, US foetal oedema; (lots of hormone problems and fluid) lymphoedema of hands and feet, koilonychia, short stature, neck webbing, wide nipples, CHD, delayed puberty, ovarian dysgenesis, hypothyroidism, renal abnormalities, pigmented moles, recurrent otitis media, normal intellect
85
Treatment of turner syndrome?
growth hormones therapy and oestrogen replacement
86
Klinefelter syndrome S+Ss?
– (tall and low sexually) infertility, hypogonadism, gynaecomastia, normal puberty, tall stature, normal intelligence; chorionic villus or amniocentesis
87
AD inheritance diseases?
achondroplasia, familial hypercholesterolaemia, Huntington’s, marfan’s, myotonic dystrophy
88
AR diseases?
congenital adrenal hyperplasia, CF, Friedreich’s ataxia, glycogen storage disorders, sickle cell (increased by consanguinity – inbreeding)
89
X-linked diseases?
colour blindness; fragile X; haemophilia; DMD/BMD (only males affected)
90
Prader-Willi S+Ss?
hypotonia, faltering growth, obesity, learning difficulties and hypogonadism
91
Nooan syndrome S+Ss?
mild learning difficulties, short webbed neck, pectus excavatum, short stature, congenital heart disease
92
Williams disease S+Ss?
short stature, congenital heart disease, mild-moderate learning difficulties
93
Glucocorticoids for neonates?
better lung maturity and surfactant production (better lungs)
94
Management for preterm labour?
antibiotics, corticosteroids, tocolysis (anti-contractions/labour), magnesium sulfate
95
Multiple birth problems?
preterm, IUGR (intrauterine growth restriction), congenital abnormalities, twin-twin transfusion
96
Problems with maternal DM?
more likely for polyhydramnios (too much amniotic fluid in sac) and pre-eclampsia (basically problems with too much fluid – osmosis); risks = macrosomia (large baby), IUGR, congenital abnormalities
97
Neonatal common problems?
hypos, resp distress, HCM, polycythaemia; foetal thrombocytopenia = risk of intracerebral haemorrhage; epidural can cause maternal pyrexia; oxytocin can cause foetal hypoxia; taxoplasmosis = bad news bears
98
Mask ventilation overview?
no breath, HR<100 and HR<60 = chest compressions
99
Non-invasive venitlation (CPAP) definition?
continuous positive airway pressure = air always into lungs to keep airways and alveoli open (no collapse) but can cause pneumothorax, reflux, feed intolerance and nasal trauma; NIPPV (nasal intermittent positive pressure ventilation); HFNC (high flow nasal cannula)
100
Invasive ventilation overview?
TCPL (time-cycled pressure limited ventilation) continuous heated and humidified gas through endotracheal tube; PTV (patient-triggered ventilation) like TCPL but triggered by a sensor detecting spontaneous breaths; HFV (high frequency ventilation); give sedation before (opiate with muscle relaxant e.g. morphine with suxamethonium); if giving pain relief give up to 50mcg/kg 5
101
Problems with acidotic infants inhaling meconium?
meconium aspiration syndrome – foetal faeces in bowel [meconium] is passed in utero so amniotic fluid is that colour); preterms prone to hypothermia; airway obstruction, surfactant dysfunction, pulmonary vasoconstriction, infection, chemical pneumonitis
102
What are Barlow's and Ortolani's?
how to check for developmental dysplasia of hip; risks = grils, positive FH, breech presentation, neuromuscular disorder
103
Examination of newborn?
birthweight, gestational age, head circ, fontanelle (where the skull plates meet), face, eyes (red reflex), palate, breathing, heart, abdo, femoral pulses, genitalia, anus, muscle tone, back, primitive reflexes, hips (everything)
104
Normal progression in neonates but can be seen as pathological?
neonatal urticaria 2/3 yrs; milia (white pimples on face); ubilical hernia resolves 2/3yrs; port-wine stain normal; strawberry naevus in 1st month
105
What is hypoxic ischaemic encephalopathy?
significant labour event (failure gas exchange, interruption of umbilical blood flow, inadequate maternal placental perfusion; leading to cardioresp depression then hypoxia/hypercarbia/metabolic acidosis)
106
Management of hypoxic ischaemic encephalopathy?
may need resp support = treatment of seizures, fluid restriction, hypotension treat, monitor hypos
107
Worrying signs with newborns?
not pink and crying (antenatal hist and check gestation); check not expanding; HR <60; use ventilation, resus and sometimes adrenaline; suck out meconium if needed
108
Some minor problems in newborns?
strawberry naevus (increase in size then disappear, bleed and ulcer); milia (pearly white papules from keratin retention in dermis); erythema toxicum (neonatal urticaria); stork mark (capillary dilation over eyelids, head and neck); swollen breasts; sticky eye (blocked tear duct but exclude chlamydia); feeding anxieties (turning blue, adjust feeding technique); red stained nappy (blood from cord/vagina/urinary urates); sneezing to clear amniotic fluid; harlequin colour change (transient, episodic demarcation erythema with contralateral blanching)
109
Birth injuries?
caput succedaneum (bruising and oedema), cephalhaematoma, chignon (bruising and oedema from ventouse), bruising to face, abrasions to skin, forcep marks; breech problems (brachial nerve palsy, humerus and femur fracture)
110
S+Ss preterm infant?
resp depression = alveolar collapse from surfactant deficiency; commoner in <28wks boys; S+Ss = tachypnoea (>60), wall recession, expiratory grunting, cyanosis
111
Treatment for preterm infants?
O2 (SEE PAGE 7 OF PAED NOTES FOR WHAT TYPE OF O2), surfactant therapy, CPAP; apnoea, bradycardia, desaturation treated with caffeine and CPAP
112
How to close patent ductus arteriosus?
prostaglandin synthetase inhibitor (indomethacin/ibuprofen used)
113
Fluids for preterm?
60-80l/kg, 150-180l/kg day 5; <35 wks = nasogastric; ill = PIC line; minerals for bone development
114
S+Ss necrotising enterocolitis?
inflammatory bowel necrosis; signs = feed tolerance, bile stained vomit, abdo distended, blood in stool, shock, tenderness
115
Risk for necrotising enterocolitis?
Cow's milk
116
Treatment for necrotising enterocolitis?
stop oral feeding and broad spectrum abx, resp/circ support; can get bowel perforation, culture faeces
117
Causes intraventricular haemorrhage?
more in low birthweight and early birth as underdeveloped vessels and stress of birthing
118
Problems with IVH?
impair CSF drainage (hydrocephalus); ventricular tap used; if dilation happens can get cerebral palsy
119
Treatment for child retinopathy?
vascular proliferation of retina and laser therapy used and can be from early oxygen exposure
120
Treatment and causes of bronchopulmonary dysplasia?
damage from pressure from artificial ventilation/oxygen toxicity/infection; O2 requirement after 36 wks
121
Pathophysiology of jaundice?
half of newborns from release of Hb from RBCs
122
Kernicterus causes?
encephalopathy from deposition unconjugated in basal ganglia and brainstem nuclei
123
S+Ss kernicterus?
athetoid movements (slow, involuntary, writhing), deafness, and low IQ if not treated; lethargy, poor feeding; can develop choreoatheoid cerebral palsy, learning difficulties, sensorineural deafness
124
Causes of haemolysis?
jaundice in 24 hours (abnormal = ABO compatibility – coomb’s test, rhesus haemolytic disease, red cell anomalies); congenital infection can cause, breastfed, dehydration, UTI, hypothyroidism, biliary atresia, neonatal hepatitis syndrome, galactosaemia (prolonged jaundice), hypterbilirubinaemia (higher bilirubin from low RBC lifespan, decreased conjugation from hepatic immaturity, breastfeeding, no gut flora to remove bile pigment); bruising and polycythaemia exacerbate
125
Treatment of jaundice in children?
phototherapy (UV converts bilirubin to excretable products – eye damage, loss of fluids and diarrhoea), exchange transfusion (must be heated)
126
Causes of resp distress in neonates?
transient tachypnoea (most common), infection, mechanical obstruction, chemical pneumonitis (meconium), pneumothorax (vigorous resus/ventilation), diaphragmatic herniation (bowel sounds in one hemithorax), premature, low weight, low surfactant (leads to atelectasis)
127
Complications of resp distress?
hypoxia leading to renal failure, low CO, hypotension and acidosis
128
Treatment of resp distress?
CPAP, high flow nasal cannula, mechanical vent., circ support, caffeine and corticosteroids (beclomethasone) in mother as increases surfactant for preterm baby and inositol promotes surfactant maturation, delay cord clamping to increase blood to baby, sats 85-93% aim; if deterioration check DOPE (Displaced ET tube, Obstruction, Pneumothorax, Equipment failure)
129
Causes and treatment of pneumonia?
rupture of membranes, chorioamnionitis, low weight; broad spectrum abx
130
Causes of persistent pulmonary hypertension?
birth asphyxia, meconium aspiration, septicaemia, RDS; cyanosed
131
What is bronchopulmonary dysplasia?
persistent hypoxia with difficult ventilator weaning; treat same as resp distress
132
What is retinopathy of prematurity?
abnormal fibrovascular proliferation/retinal vessels = retinal detachment/visual loss
133
Causes of retinopathy of prematurity?
premature, low weight, supplement O2
134
Treatment of retinopathy of prematurity?
Diode laser therapy
135
Causes of sepsis?
bacteria from birth canal into amniotic fluid
136
S+Ss sepsis?
pneumonia and secondary bacteraemia; resp distress and temp instability
137
Investigations and treatment of sepsis?
sepsis screen (supportive, bloods, cultures, CXR, LP); treat with benzylpenicillin, amoxicillin and gentamicin; late onset usually staph epidermis and give flucloxacillin and gentamicin; resistance = vancomycin; group B strep, risk are same as pneumonia and give prophylactic abx
138
Listeria causes and S+Ss?
rare but from unpasteurised milk, soft cheese and undercooked poultry; flu-like, bacteraemia, widespread rash, meconium stained liquor
139
Treatment for conjunctivitis?
clean with saline; neomycin to treat redness; discharge can lead to gonococcal infection; stop before vision loss; chlamydia with purulent discharge and eye swelling and use erythromycin
140
S+Ss herpes simplex?
4 wks with local herpetic lesions and encephalitis; acyclovir for systemic
141
S+Ss hypoglycaemia?
irritability, apnoea, lethargy, drowsiness, seizures (like adult);
142
Prevention and treatment of hypos?
early milk and regular feeding prevent; glucose>2.6 IV needed and if not work then glucagon
143
What is a cleft lip?
no fusion frontonasal and maxillary processes
144
What is a cleft palate?
palatine processes and nasal septum
145
Repair of cleft palate/lip?
3 months; feeding tricky, secretory otitis media common
146
What is Pierre Robin and treatment?
micrognathia, posterior displacement of tongue and midline cleft of soft palate; mother to quit smoking and take folic acid
147
S+Ss small bowel obstruction?
persistent vomiting (bile stained); meconium passed; abdo distension if more distal
148
Causes of small bowel obstruction?
from duodenal atresia, congenital malformations, volvulus, meconium ileus
149
Treatment of small bowel obstruction?
Surgery
150
What happens in Hirschsprung's?
absence of ganglion cells on myenteric and submucosal plexuses in large bowel, narrowed segment; explosive faeces and wind; use rectal suction biopsy of aganglionic bit
151
Treatment for large bowel obstruction?
nasogastric tube passed and aspirated; IV fluids
152
What is examphalos?
abdo contents through umbilical ring
153
What is gastroschisis?
bowel through defect in anterior abdo wall
154
What are the 4 phases of growth?
foetal, infantile, childhood and pubertal growth spurt
155
What is the foetal growth phase?
size of mother and placental nutrient supply; severe IUGR = permanent short stature
156
What is the infantile growth phase?
18 months from nutrition, thyroid and good health; 15% of final height
157
What is the childhood phase of growth?
slow and steady; pituitary GH dependent (IGF-1 at epiphyses); can be decreased by chronic unhappiness; testosterone and oestradiol increase; measure = height, weight, head circ, BMI
158
Overview of puberty for women?
breast development (8.5-12.5yrs), pubic hair growth, menarche (2.5 yrs after puberty start)
159
Overview of male puberty?
testicular enlargement, pubic hair growth, rapid height
160
Overview of join male and female puberty changes?
acne, axillary hair, BO, mood changes; measure bone age and pelvic US if early/late
161
Definition of short stature?
height below 2nd centile; should be a year apart (measuring velocity = growth failure indicator)
162
What is the height centile?
mean of mother and father’s height +7 for boys and -7 for girls
163
What is constitutional delay?
variation of normal growth but still end up the same; GH treatment if insufficient growth by 4yrs
164
Causes of short stature?
low nutrition; coeliacs, crohns, CKD, CF and CHD; physical and emotional deprivation; hypothyroidism, GH deficiency, IGF1 deficiency, steroid excess, Cushings; GH low from primary or secondary to pituitary dysfunction (craniopharyngioma, hypothalamic tumour, head injury, meningitis)
165
How to identify short stature?
sitting height, subischial leg length (sitting-normal height), limited radiographic skeletal survey
166
Definition of micro and macrocephaly?
microcephaly = below 2nd centile, macro = above 98th centile
167
Causes of high ICP?
hydrocephalus, meningoencephalitis, head injury, sub/extradural bleeds, hypoxia, ketoacidosis, tumours, thrombosis
168
Other problems with the head in neonates?
), subdural haematoma, tumour; plagiocephaly (parallelogram head) is from babies on back and hypotonia; premature fusion of sutures = head distortion
169
Definition of premature sexual development?
<8yrs for girls and <9 for boys is abnormal
170
S+Ss premature sexual development?
precocious puberty, thelarche (breasts – between 6 months and 2yrs), pubarche, isolated premature menarche; gonadotrophin independent = excess androgens or adrenal tumours; gonadotrophin dependent = pituitary adenoma; GDPP common in girls; teste enlargement = GDPP but if only one bigger then gonadal tumour; prepubertal testes = independent
171
Causes of premature pubertal development?
hypothalamic hamartoma, LH receptor gene mutations, sporadic, familial male gonadotrophin-independent precocious puberty
172
Hx of premature sexual development?
polyuria, polydipsia, obesity, sleep, temp, high ICP, visual disturbance
173
Treatment of premature sexual development?
reduce rate of skeletal maturation, address psych and behavioural concerns and sometimes GnRH analogues to suppress by -ve feedback; can use inhibitors of androgens/oestrogen sometimes for independent (sometimes spironolactone)
o Differentiate adrenal hyperplasia from pubarche by urinary steroid profile, levels of blood androgens and bone age – more likely to have polycystic ovary syndrome
174
Treatment of delayed puberty in men?
oral oxandrolone used or IV testosterone in older boys
175
When need most nutrition?
1st 6 months
176
Why is breastfeeding good?
protective against necrotising enterocolitis and DM2 and breast/ovarian cancer for mum
177
Recommended intake for water, energy, protein, carbs?
• Water = 180mL/kg/day; energy = 130kal/day; protein = 2.5-3.1g/100kcal; 4.7-9g/kg; carbs = 7-14g/100kcal
178
Dehydration treatment?
dioralyte, IV fluids if needed using the calc (moderate to severe), use intraosseous route; pre-existing deficit = %dehydration x kg x 10
179
Dehydration S+Ss?
mild = 5%, moderate 10 and severe >10; weight loss, less skin turgor, tenting, shock, hypotension, high pulse, low cap refill, lethargy; careful of sudden changes in sodium levels
180
What is intraosseus transfusion for?
venous access (cv arrest, severe burns, prolonged status epilepticus, hypovolaemia, septic shock)
181
When no to use intraosseus transfusion?
don’t use for brittle bones (osteogenesis imperfecta, osteoporosis, infection, fracture at sight); goes into BM
182
Timeline for food in babies?
• COLOSTRUM – 1st few days of milk and more Igs; cow’s milk after 12 months and full fat until 5yrs; solid foods from 6 months
183
Hx for weight of babies?
week 1, 8, 12, 16 and 1 year; to ask = history of milk feeding, age of weaning, range of food, mealtime routine, 3-day food diary, weight centiles to assess weight faltering
184
At risk to malnutrition?
o Long-term illness most at risk; anorexia, malabsorption, increased energy requirements
185
Tests for malnutrition?
asked to keep 7 day food diary; nutritional assessment = anthropometry (physical proportions), labs (albumin and V+M), immunodeficiency
186
When to give enteral feeding?
when GI tract works; give continuously overnight
187
What is parenteral feeding?
all basic energy and vitamins given as solution
188
What to give parenteral feeding for?
for short bowel syndrome, enteropathies, motility disorder
189
Marasmus S+Ss?
(lack of calories – more than 3 standard deviations below weight-height ratio) = child wasted, withdrawn and apathetic
190
Kwashiorkor S+Ss?
(recurrent infection – low protein and aas) = generalised oedema and wasting, can develop acute infection like measles/gastroenteritis
191
General severe protein-calorie malnutrition?
flaky skin rash, abdo distension, angular stomatitis, sparse hair, diarrhoea, low plasma, glucose and electrolytes; often from breast milk before 12 months
192
Treatment of severe malnutrition?
stop hypos, hypothermia, dehydration; correct electrolytes; treat infection; micronutrient support and initiate feeds; sensory stimulation and emotional support
193
Problems with vit D deficiency?
rickets, osteomalacia, hypocalcaemia
194
Rickets and osteomalacia S+Ss?
both problems in mineralisation but rickets growing and the other one grown, when triggers hyperparathyroidism to normalise serum calcium but brittle bones; phosphate excreted and low serum so less absorption of calcium into bones
195
Hypocalcaemia S+Ss?
seizures, neuromuscular irritability, apnoea and cardiomyopathy); <2yrs more common and adolescence
196
Risks to increase vit D deficiency?
intestinal malabsorption, northern, dark skin, strict diets and prolonged PN
197
Diagnosis and S+Ss rickets?
in wrists, occipital/parietal bones, ankles, horizontal depression of chest, legs bowed; diagnose = diet hist, bloods, x-ray of wrist
198
Treatment of rickets?
D3 and correct other factors
199
Problems associated with obesity?
changes in bones, hypoventilation syndrome, NAFLD, gallbladder disease, DM2, HT, abnormal blood lipids and psych problems
200
Causes of obesity?
diet, exercise, low sleep = low leptin and high ghrelin, socioeconomic, meds; BMI>91st centile and obese >98th; <3yrs = genetics
201
Management of obesity?
change lifestyle (diet and exercise); change fam perceptions, orlistat (causes steatorrhoea)
202
Causes of childhood caries?
poor diet and oral health; psychosocial factors; streptococcus mutans and sobrinus
203
Prevention of childhood caries?
mouthwash, avoid sharing utensils, oral health edu, drink from own cup, wean from bottle 12-14 months, daily brushing, fluoridated water
204
What is posseting?
small amounts of milk with air brought up (not quite regurgitation and this isn’t quite as strong as vomiting which is forceful ejection of gastric contents); usually benign and sometimes mild GORD
205
Causes of vomiting?
bilous/prolonged/systemically unwell/faltering growth = RTI/UTI, pyloric stenosis, intestinal obstruction
206
S+Ss GORD?
regurg, distress after feeds, apnoea, pneumonia, failure to thrive, anaemia; inappropriate relaxation of LOS (fluid, diet, horizontal posture, short intraabdo length); most resolves in 12 months; common in cerebral palsy, preterm, surgery for oesophageal atresia (polyhydramnios, small stomach, cough, airway obstruction, lots of secretions, blowing bubbles, distended abdo, cyanosis, aspiration, can’t pass catheter to stomach)
207
Investigations of GORD?
24 hour oesophageal pH monitoring, impedance monitoring and endoscopy (biopsies)
208
Treatment of GORD?
thickening agents and smaller, frequent feeds; severe = H2 antagonists and PPIs then surgery; alginates
209
S+Ss pyloric stenosis?
vomiting after feeds (no bile and large volume) and hunger after it, dehydration and weight loss, no diarrhoea; hypo (K+, Na+ and Cl-)
210
Diagnosis of pyloric stenosis?
test feed, pyloric mass RUQ, US
211
Treatment of pyloric stenosis?
IV fluids, pyloromyotomy
212
Causes of abdo distension?
air = faecal impaction, air swallowing, malabsorption; ascites = nephrosis, hypoprotinaemia, cirrhosis; solid masses = wilms tumour, neuroblastoma, adrenal tumour; cysts = polycystic kidneys, hepatic, dermoid, pancreatic
213
S+Ss colic?
paroxysmal; inconsolable crying, drawing up knees, lots of flatus
214
Causes of colic?
if severe could be cow’s milk allergy; acute = appendicitis
215
Tests for colic?
o Check – testes, hernial orifices, hip joints, lower lobe pneumonia, DKA, UTI and pancreas
216
S+Ss acute appendicitis?
anorexia, vomiting, abdo pain, fever, pain from movement, guarding at McBurney’s point; faecoliths in schoolchildren; perforations high in <5yrs
217
Treatment of acute appendicitis?
fluid resus and abx; symptoms progress = surgery
218
What is intussusception?
invagination of proximal bowel into distal; usually ileum into caecum through valve; most common cause of kid GI obstruction; 3 months-2 yrs
219
Complications of acute appendicitis?
stretching and constricting mesentery; venous obstruction, bowel bleeding, perforation, peritonitis, gut necrosis
220
S+Ss appendicits?
paroxysmal colicky pain, pallor, refuse feeds, vomiting, sausage shaped mass, red jelly stool, abdo distension; abdo US and Xray
221
Treatment of intussusception?
IV fluids; rectal air insufflation; surgery for rest
222
Complications from intussuception?
could be volvulus or diverticulitis or Meckels diverticulum; green vomit need to check upper GI for malrotation
223
Definition of recurrent abdo pain?
interrupts ADLs and 3 months+
224
S+Ss recurrent abdo pain?
periumbilical; constipation = most common; others = anxiety, anal fissures, growth, GI/UTI infection (urine microscopy and culture), coeliac/crohns, thyroid, IBS (non-specific bloating, feeling of incomplete defecation, epigastric pain), abdo migraine (abdo and head pain – use triptans), duodenal/peptic ulcers (PPIs/abx for H.Pylori)
225
What is eosinophilic oesophagitis and treatment?
inflammatory from eosinophil activation in mucosa; atopy; use oral corticosteroids
226
Causes of gastroenteritis?
mainly rotavirus, others = noro, astro and adenovirus; also campylobacter jejuni (severe abdo pain), shigella (blood and pus in stool with tenesumus), cholera and e.coli (severe diarrhoea – dehydration), protozoan with giardia or cryptosporidium; normal diet after this can cause watery stool
227
Risks of dehydration?
<6 months with low weight, >6 stools in 24 hours, >3 vomits in 24 hours, malnutrition, can’t tolerate fluids
228
S+Ss hyponatraemia?
seizures
229
S+Ss hypernatraemia?
jittery movements, increased tone, altered consciousness, seizure, small multiple haemorrhages
o Diarrhoea in developing countries could be low zinc
o Prevent with good hygiene and education
230
Causes of diarrhoea?
secretory = low absorption or high secretion (watery); osmotic = watery, acidic and +ve for reducing substances; motility disorders, increased = thyrotoxicosis, decreased = intussusception; inflammatory = bloody stool
231
What is gastroschisis?
paraumbilical defect with evisceration (viscera extrudes) of abdo contents; find with US
232
Treatment of gastroschisis?
cover exposed bowel with clingfilm and keep baby warm and hydrated at birth; surgery; may take a while for GI function to resume (few weeks)
233
What is exampholos/omphalocele?
ventral defects of umbilical ring with abdo viscera herniation; small might only have meckel’s diverticulum but larger = stomach, liver, bladder
234
Treatment of exampholos/omphalocele?
protect, keep hydrated, keep warm, gastric decompression, prevent sepsis, keep CV healthy, surgical closure
235
S+Ss and causes of malabsorption?
abnormal stools, poor weight gain, specific nutrient deficiencies; usually 8-24 months; other signs = faltering growth, abdo distension, buttock wasting, abnormal stools, general irritability; could be coeliacs (6 weeks plus serology and endoscope with villous atrophy – enteropathy from gluten), short bowel syndrome
236
S+Ss persistent loose stools?
chronic non-specific diarrhoea, IBD, Crohn’s (looks like anorexia)
237
Diagnosis persistent loose stools?
raised inflammatory, iron deficiency anaemia, low serum albumin, endoscope
238
Treatment of persistent loose stools?
diet, steroids, immunosuppressants (azathioprine, mercaptopurine), anti-TNF, surgery if complications
239
S+Ss UC?
rectal bleeding, diarrhoea, colicky pain, weight loss, growth failure; colonoscopy diagnosis
240
Treatment UC?
mesalazine (mild), steroids, immunomodulation and infliximab/ciclosporin (resistant disease); 10 years colonoscopy after diagnosis
241
S+Ss constipation?
<3 stools per week, large and hard, rabbit droppins, distress/strain/bleeding, abdo pain, masses, overflow soiling, megarectum, anorexia
242
Causes of constipation?
hirschsprung’s (can’t pass meconium in 1st 24 hours, intestinal obstruction, chronic constipation, abdo distension, growth failure), coeliac, hypercalcaemia, anorectal abnormalities, hypothyroidism, diet, poor fluid, fibre intake
243
Treatment of constipation?
stool softeners (polyethene glycol, electrolytes), stimulant laxatives (senna), osmotic laxatives (lactulose), rehydrate with movicol; sometimes enemas
244
Causes of allergies?
• 40% have allergic rhinitis/asthma/eczema, 6% have food allergy; IgE (early phase and late phase response – more severe) or non-IgE mediated (delayed onset and varying clinical course); eczema and food usually in infancy and rest at primary school age
245
S+Ss allergies?
mainly resp) mouth breathing, allergic salute (rubbing itchy nose), pale/swollen inferior nasal turbinates, hyperinflated chest, atopic eczema on limb flexures, allergic conjunctivitis; growth checked
246
Causes of food allergies?
usually IgE; normally react on 1st exposure; milk, peanuts, eggs (can resolve); older = nuts and fish
247
IgE mediated allergies S+Ss?
urticaria, facial swelling, anaphylaxis (classic allergy reaction); skin prick test and IgE levels
248
Non-IgE mediated allergies S+Ss?
diarrhoea, vomiting, abdo pain, faltering growth (more like gastro problem), blood in stools in first weeks of life; intestinal biopsy and endoscopy; double-blind placebo-controlled food challenge
249
Management of allergies?
avoidance, training and education, non-sedating antihistamines, epinephrine for severe
250
Treatment of anaphylaxis?
resus; pt on back with legs raised/in position of comfort; ABCDE (e = exposure of skin); adrenaline; repeat with high flow O2 and crystalloid; salbutamol for bronchoconstriction; may have to give epi pen afterwards and always record
251
Causes of eczema?
atopic or non-atopic; impairment of skin barrier function; 40% in infants have IgE food allergy; skin test
252
Causes allergic rhinitis?
atopic or non-atopic; intermittent, persistent or mild; can be seasonal; post-nasal drip, chronically blocked nose
253
S+Ss rhinoconjunctivitis?
urticaria can lead to angioedema, anaphylaxis
254
Treatment rhinoconjunctivitis?
non-sedating antihistamines or omalizumab; topical corticosteroid nasal/eye preparations, cromoglycate eye drops, leukotriene receptor antagonists, nasal decongestants, allergen immunotherapy
255
Tests for child with temp >37.5 degrees?
4 weeks = axilla thermometer and after this tympanic; septic screen (blood culture, FBC/WBC, CRP and urine [UTI], blood gas, glucose) and broad spectrum abx (unless cause found); CSF = CXR, LP, rapid antigen screen, meningococcal/pneumococcal/virus PCR
256
Risks to increase chance of febrile child?
= ill fam, illness in community, low immunisations, recent travel, animal contact and immunodeficiency, prolonged membrane rupture, maternal carrier of group B strep, preterm labour, fetal distress, breaks in skin/mucosa, chorioamnionitis, central lines and catheters
257
Red flags for febrile child?
fever >38, pale/cyanosed, reduced GCS, neck stiffness, neuro signs, resp distress, bile-stained vomit and severe dehydration
258
Treatment for febrile child?
PN abx (broad spectrum until blood cultures confirm e.g. benzylpenicillin and gentamicin) for seriously unwell (cefotaxime), ampicillin for <1 month for listeria and antipyretics
259
S+Ss bacterial meningitis?
mainly <16; can have neuro impairment from it, irritable, abnormal cry, lethargy, difficulty feeding; cerebral oedema, raised ICP, decreased cerebral blood flow, fibrin deposits lower CSF absorption (hydrocephalus); meningeal signs (after septic = high temp, cold peripheries, limb/join pain, odd behaviour, skin colour change, rash) = Brudzinski and Kernig signs; LP contraindicated if cardioresp instability, raised ICP and focal neuro signs
260
S+Ss high ICP?
listless, irritable, drowsy, headache, diplopia, vomiting, tense fontanelle, low GCA (pupil changes, abnormal posturing), cushing’s triad (imminent coning – slow pulse, high bp, breathing abnormal)
261
Management of high ICP?
ABC, tilt head elevated 25 degrees, treat symptoms (seizures and high temp with O2), intubate, mannitol, dexamethasone, fluid restriction, send to neurosurgery
262
Types of abx used for serious infections?
Cephalosporins
263
Investigations bacterial meningitis?
cloudy CSF with polymorphs, increased protein and decreased glucose (TB same but lymphocytes instead of polymorphs)
264
Organisms causing bacterial meningitis?
Neisseria meningitis, H influenzae, strep pneumoniae, E coli, group B haemolytic strep, listeria monocytogenes, TB
265
Causes of viral meningitis?
mumps, echo, herpes, polio
266
Tests for viral meningitis?
clear CSF, lymphocytes and normal protein/glucose
267
Cerebral complications from meningitis?
hearing impairment, local vasculitis, subdural effusion, hydrocephalus, cerebral abscess; prophylaxis for fam = rifampicin/ciprofloxacin
268
Treatment for meningitis?
ceftriaxone
269
What is encephalitis?
direct invasion of brain by neurotoxic virus (HSV – herpes is most treatable - and enteroviruses), delayed brain swelling, slow virus infection, delayed brain swelling after dysregulated neuroimmunological response
270
S+Ss encephalitis?
fever, altered consciousness, seizures
271
Treatment of encephalitis?
HSV give acyclovir; EEG and CT/MRI
272
Causes of toxic shock syndrome?
S.aureus and group A strep
273
S+Ss toxic shock syndrome?
= fever >39, hypotension, diffuse erythematous rash, organ dysfunction and impaired consciousness
274
Treatment of toxic shock syndrome?
intensive care, IV ceftriaxone/clindamycin and IV ig
275
Treatment for meningococcal infection?
usually full recovery, early penicillin and inotropes may be needed, rifampicin prophylaxis for contacts; septicaemia = purpura rash
276
What can S.pneumoniae cause?
pharyngitis, otitis media, conjunctivitis, sinusitis and meningitis (basically all neck/face swellings)
277
S+Ss impetigo?
localised, highly contagious skin infection, staph/strep, common in eczema, lesions on face/hands (honey-crusted)
278
Treatment of impetigo?
topical abx in mild and flucloxacillin in severe
279
What is a boil?
staph aureus infection of hair follicles/sweat glands
280
Treatment of boils?
systemic abx and excision
281
S+Ss periorbital cellulitis?
fever, erythema, tenderness and oedema of eyelid
282
Abx for periorbital cellulitis?
ceftriaxone
283
S+Ss orbital cellulitis?
proptosis, reduced visual acuity, painful ocular movement
284
What is staphylococcal scalded skin syndrome?
separation of epidermal skin; fever, malaise, localised infection (eyes, nose, mouth)
285
Treatment of staphylococcal scalded skin syndrome?
manage with IV flucloxacillin, analgesia and fluid balance
286
Types of HSV?
type 1 = skin and lip lesions, 2 = genitals
287
Complications of HSV?
blepharitis (eyelid) or conjunctivitis, pneumonia and disseminated infection in immunocompromised; eczema herpeticum (widespread lesions on eczema, can get herpetic whitlows)
288
Treatment of HSV?
acyclovir
289
S+Ss roseola infantum?
gives high temp, maculopapular rash, uvulo-palatoglossal ulcers
290
S+Ss gingivostomatitis?
10m-3y with vesicular lesions on lips and gums, tongue and hard palate; ulceration and bleeding (painful E+D), dehydration
291
S+Ss varicella zoster?
; lesions on head and trunk to peripheries; infect = 4 days before rash then all lesions scabbed, droplet spread; spots blackish/blueish/coalescing then ITU and no ibuprofen
292
Complications varicella zoster?
= staph infection, encephalitis, purpura fulminans
293
Treatment serious varicella zoster?
; IV acyclovir for serious and immunocompromised with antivaricella-zost igs; use calamine lotion to soothe; shingles/herpes zoster uncommon but usually after 1st year
294
Complications in baby with mother with herpes zoster?
microcephaly, severe chicken pox, convulsions, cerebral hypoplasia etc
295
S+Ss EBV?
oral spread; older = fever, malaise, tonsillitis, lymphadenopathy, petechiae on soft palate, splenomegaly, maculopapular rash, jaundice
296
Diagnosis EBV?
atypical lymphocytes, positive monospot test or seroconversion
297
CMV mode of transition?
saliva, genital secretions, breastmilk
298
CMV immunocompromised S+Ss?
retinitis, pneumonitis, bone marrow failure, encephalitis, hepatitis, oesophagitis, enterocolitis; high fever and malaise for few days then generalised macular rash
299
Treatment for CMV?
ganciclovir
300
S+Ss human parvovirus B19?
slapped cheek syndrome and in spring; respiratory secretions transmission; asymptomatic or fever, malaise, headache and myalgia; aplastic crisis in chronic haemolytic anaemia; sometimes hydrops fetalis
301
S+Ss enteroviruses?
loose stools, vomiting, rash non-blanching then ceftriaxone unless sepsis excluded; can cause myocarditis/pericarditis
302
Mode of admission for enteroviruses?
faecal-oral or resp droplets
303
What is herpangina?
painful lesions causing tricky swallowing and fever
304
What is pleurodynia?
fever, pleuritic chest pain, muscle tenderness
305
S+Ss measles?
(7-12 days incubation) = fever, runny nose (coryza), cough, conjunctivitis, marked malaise, Koplik spots and maculopapular rash
306
Complications of measles?
otitis media, encephalitis and subacute sclerosing panencephalitis (7-13yrs after = behaviour changes, myoclonus, choreoatheotosis, dystonia, dementia, coma)
307
Treatment of measles?
isolation, supportive and ribavirin in immunocompromised
308
S+Ss mumps?
; incubation 15-24 days; fever (stops after 3-4 days), malaise
309
Parotitis S+Ss?
(infective 7 days before and 9 days after), E+D difficult; plasma amylase high and orchitis common
310
Rubella S+Ss?
mild illness, low grade fever, maculopapular rash on face (fades 3-5 days – infective 5 days before and after rash), suboccipital lymphadenopathy; incubation 15-20 days; resp route; diagnosis serology
311
S+Ss and overview kawasaki?
systemic vasculitis (coronary artery aneurysm), Japanese mainly; high inflammatory markers and platelets rise in 2nd week; conjunctivitis, red mucous membranes, cervical lymphadenopathy, red palms, eyes and soles, lips and peeling of skin later, high fever
312
Treatment kawasaki?
IV ig to lower aneurysm risk, aspirin or warfarin; inflammation and fever use corticosteroids, infliximab or ciclosporin
313
Tests for HIV in babies?
>18 months = ab test but <18 month = DNA PCR as get mother’s IgGs from breast milk so false positives
314
S+Ss HIV in kids?
mild = lymphadenopathy, parotid enlargement; moderate = recurrent bacterial infections, candidiasis, diarrhoea, thrombocytopenia, hepatospleomegaly; lymphocytic interstitial pneumonia
315
Treatment of HIV?
HAART (antiretroviral therapy) but before this use PENTA, HIV viral load, CD4 count, prophylaxis of PCP with cotrimoxazole, vaccines, weight/development/clinical monitoring
316
Factors reducing maternal transmission of HIV?
ART in pregnancy, PEP after birth, no breastfeeding, C-section
317
S+Ss lyme disease?
= erythema migrans and expanding lesion (bullseye), fever, headache, malaise, myalgia, arthralgia, lymphadenopathy; dissemination = rare (2+ colonised sites) but can cause CN palsies, meningitis, arthritis, carditis
318
Treatment of lyme disease?
>12 use doxycycline and amoxicillin
319
S+Ss URTI?
difficulty feeding, febrile seizures, acute asthma exacerbations, nasal discharge and blockage
320
Common URTIs?
rhinovirus, coronavirus, resp syncytical virus, group A beta-haemolytic, enterovirus, adenovirus
321
Treatment URTIs?
paracetamol/ibuprofen
322
What is pharyngitis?
pharynx and soft palate with lymphadenopathy
323
What is tonsillitis?
pharyngitis with exudate and intense inflammation
324
S+Ss tonsillitis?
headache, abdo pain, white exudate, cervical lymphadenopathy (bacterial)
325
Treatment tonsillitis?
10 day course abx
326
S+Ss scarlet fever?
group a strep, 5-12 yrs, fever before tonsillitis, headache, sandpaper maculopapular rash
327
Causes of acute otitis media?
RSV, rhinovirus, pneumococcus, H.influenzae, Moraxella catarrhalis
328
S+Ss acute otitis media?
bright red and bulging on otoscope; decreased hearing, eardum dull and retracted, fluid; conductive hearing loss
329
Treatment otitis media?
anaesthesia with P+I
330
Causes of stridor?
most common from laryngeal and tracheal infection (mainly viral croup and sometimes parainfluenza), foreign body, bacterial tracheitis, epiglottitis
331
Severity of stridor assessed?
stridor character and degree of chest retraction also cyanosis and ABCD
332
S+Ss complete resp obstruction?
central cyanosis, drooling, reduced consciousness
333
Causes of acute stridor with no infection?
anaphylaxis/foreign body; if nothing works then think bacterial tracheitis (mucosal sloughing that can’t be cleared and exudate)
334
S+Ss croup?
6 months-6 yrs; autumn; coryza (catarrh) and fever then hoarseness, barking cough, harsh stridor, worse at night, subglottic oedema, inflammation ad exudate
335
Treatment of croup?
oral dexamethasone/prednisolone and severe = nebulised adrenaline and O2
336
S+Ss epiglottitis?
intense swelling with septicaemia; emergency; from Hib; 1-6yrs; high fever, ill, painful throat, soft inspiratory stridor, resp difficulty, sitting immobile
337
Treatment epiglottitis?
don’t lie down/spatula in throat; intubate, blood culture, IV abx (cefuroxime) 3-5 days, rifampicin for fam, may need tracheostomy if occluded too much
338
S+Ss diphtheria?
usually starts with tonsillitis and sometimes membrane over fauces (back of mouth leading to pharynx); can get polyneuritis mainly with CNs, shock from myocarditis, toxaemia or cardiac conduction system involvement; other signs = dysphagia, muffled voice, bronchopneumonia, brassy cough then airway obstruction
339
Diagnosis diphtheria?
swab culture of below pseudomembrane
340
Treatment diphtheria?
diphtheria antitoxin and erythromycin for 7 days
341
Causes of wheeze?
mucosal inflammation, swelling and mechanical obstruction
342
S+Ss bronchiolitis?
1-9months – LRTI, coryza, cough, fever, tachypnoea, wheeze, inspiratory crackles, apnoea sometimes cyanosis
343
What is RSV?
respiratory syncytial virus
344
Wheeze S+Ss?
coryzal, dry wheezy cough, SOB, feeding tricky, recurrent apnoea (serious in young), tachypnoea/cardia, chest hyperinflation, sub/intercostal recession, fine end inspiratory crackles, high-pitched wheezes
345
Treatments wheeze?
O2 sats and CXR; give steroids and nebulised adrenaline and only ribavirin for immunocompromised
346
When to refer to a specialist with wheeze?
apnoea, <90% sats, low fluid intake, severe resp distress; give humidified O2, NG/IV fluids, CPAP and MV sometimes, reduce infectivity; most recover in 2 wks, RSV v infective, permanent damage sometimes in adenovirus
347
S+Ss viral wheezing?
episodic wheezing, multiple trigger wheeze and asthma
348
S+Ss asthma?
– polyphonic and diurnal variation; not usually hyperinflation unless attack
349
Treatment for asthma?
LABAs effective for 12 hours; prednisolone/beclametasone; salbutamol = spacers in kids; ipratropium bromide (anticholinergic bronchodilator) after other bronchodilators don’t work; motelukast/theophylline = leukotriene receptor antagonists; anti-IgE with omalizumab in severe
350
When to hospitalise in asthma?
hospitalise if no improvement after high bronchodilator dose, exhausted, silent chest, cyanosis, hypotension, PEFR <33%, <50% peak flow, <92% sats = bronchodilators, steroids, O2, IV mg sulfate/salbutamol/aminophylline; if emergency use all the above treatments and consider CPAP
351
RFs TB?
Overseas contacts and HIV?
352
S+Ss TB?
anorexia, low fever, failure to thrive, malaise, cough common
353
Diagnosis TB?
tuberculin tests, blood, ziehl-neelson stain of sputum; miliary spread rare but dangerous
354
Treatment of TB with RIPE?
rifampicin, isoniazid, pyrazinamide, ethambutol; co-trimoxazole prophylaxis if with HIV for pneumocystitis
355
Indications of a dry cough with prolonged expiratory phase?
narrowing of small-moderate sized airways
356
Indications from a barking cough?
tracheal inflammation
357
Indications from a moist cough?
LRTI
358
Define a whooping cough, cough?
paroxysmal/spasmodic cough (worse at night and can be vomit) followed by inspiratory whoop
359
S+Ss whooping cough?
paroxysm = goes red and blue and mucous out mouth, sometimes epistaxis and conjunctival haemorrhages (3 months); cough only last 25 days and if after might be lobar collapse; pneumonia, seizures and bronchiectasis can happen but rare
360
Diagnosis whoopin cough?
perinasal swab, PCR, marked lymphocytosis
361
Prevention of whooping cough?
close contacts get macrolide prophylaxis (also for treat), vaccination, no parental smoking
362
Causes of pneumonia?
newborns = group B strep and gram -ve enterococci; infants = RSV, strep pneumoniae, H.influenzae; 5+ = mycoplasma pneumoniae
363
S+Ss pneumonia?
fever, cough, tachypnoea, lethargy, poor feeding, unwell; pleural irritation (bacterial), crackles; sometimes empyema
364
Diagnosis pneumonia?
CXR, nasopharyngeal aspirate, cultures if bad
365
Treatment of pneumonia?
O2 if <92%, analgesia, new-borns = broad spectrum abx, older = amoxicillin, chronic = high dose co-amoxiclav with physio
366
Pathophysiology CF?
defective CF transmembrane conductance regulator (CFTR gene – chromosome 7); bad ion transport across epithelium, impaired cilia function, retention of mucopurulent secretions; pancreatic ducts blocked, low defence against infections and dysregulated inflammatory response; pancreatic enzyme blocked so malabsorption (steatorrhea)
367
S+Ss CF?
nasal polyps and sinusitis, failure to thrive and slow growth, meconium ileus (can’t pass stool in 1st 2 days of life; older = DM, cirrhosis, pneumothorax and sterility in males, chest infections
368
Screening infants for CF?
immunoreactive trypsinogen, low faecal elastase (pancreatic insufficiency), sweat test for chloride (can have false +ve if really young, some diseases or false -ve if oedema), spirometry, 95% die of resp failure; older = spirometry
369
Treatment CF?
reg = no symptoms; physio twice/day, exercise, continuous prophylactic abx, nebulised DNase or hypertonic solution (reduces sputum viscosity), azithromycin, lung transplant sometimes, high calorie diet and enzymes (pancrex) and omeprazole increases absorption, gastrotomy overnight, if infection gentamicin with ticarcillin
370
What is primary ciliary dyskinesia?
abnormal cilia function/structure; low mucociliary clearance, lots of URTI/LRTI
371
S+Ss primary ciliary dyskinesia?
recurrent productive cough, purulent nasal discharge, chronic ear infections, ½ have dextrocardia, obstructive sleep apnoea
372
Assessment of primary ciliary dyskinesia?
O2 sats, electrophysical assessment
373
Normal HSs in paeds?
asymptomatic, soft blowing murmur systolic and left sternal edge, Still’s murmur; no symptoms of cardiac abnormalities
374
HF S+Ss?
SOB, sweating, poor feeding, recurrent chest infections, poor weight gain, tachypnoea/cardia, murmur, cardiomegaly, hepatomegaly, cold peripheries, acidosis
375
Investigations HF?
FBC, CXR, paO2, ECG, ECHO, cardiac catheter
376
Management of HF?
sit-up; o2; ng feed; diuretics (furosemide with/out spironolactone); alprostadil for duct dependent cyanosis
377
Causes of HF/CHD?
neonates = hypoplastic left heart syndrome, aortic stenosis, coarctation of the aorta, interruption of aortic arch; infants = VSD, ASD and ductus arteriosus; older = cardiomyopathy, Eisenmenger and RHD; usually starts off as left-right shunt (pulmonary oedema and SOB) then to Eisenmenger’s syndrome (irreversible and raised pulmonary vascular resistance, cyanosis); congenital HD = chest radiograph and ECG; shock happens in severe left heart obstruction
378
ASD types (atrial septal defects)?
secundum (defect involving foramen ovale) and partial (defect of AV septum – bottom of atrial septum, AV valves); usually asymptomatic
379
ASD S+Ss?
ejection systolic murmur, fixed/wide 2nd HS, pansystolic murmur, cardiomegaly, enlarged pulmonary arteries, increased vascular markings
380
VSD S+Ss?
small = symptomatic; large = loud pansystolic murmur at left sternal edge with quiet P2, tachypnoea/cardia, hepatomegaly, active precordium, soft pansystolic, apical mid-diastolic murmur, loud P2, cardiomegaly, enlarged pulmonary arteries, increased vascular markings, pulmonary oedema, ventricular hypertrophy
381
Treatment of VSD?
diuretics (captopril), more calories, pulmonary HT 3-6 months
382
What is patent ductus arteriosus (PDA)?
haven’t closed by 1 month then constrictor mechanism defect
383
PDA S+Ss and treatment?
continuous murmur below left clavicle, collapsing pulse, HF and pulmonary HT, thrill, collapsing pulse, pneumonia, loud S2; closure to abolish risk of bacterial endocarditis
384
Types of right-left heart shunts?
tetralogy of Fallot, translocation of the great arteries
385
Right-left heart shunts S+Ss?
cyanosis in 1st week; nitrogen washout test in cyanosed, 100% O2 for 10 mins and right radial artery PaO2 low then HD
386
Management of cyanosis?
ABC, prostaglandin infusion
387
S+Ss tetralogy of fallot?
large VSD, overriding aorta, subpulmonary stenosis, RVH; older = loud ejection systolic at left sternal edge, clubbing; ECG normal, CXR = small heart, untilted apex, decreased vascular markings
388
Treatment fallot?
surgery at 6 months; hypercyanotic spells = sedation, pain relief, IV propranolol, IV volume administration, bicarbonate, artificial ventilation; TOGA = aorta connected to RV and PA to LV and do atrial switch surgery and balloon atrial septostomy
389
Common mixing defects in the heart?
AVSD (in Down’s) and complex congenital HD
390
AVSD and complex congenital HD S+Ss?
cyanosis/HF at 2wks, no murmur, ECG superior axis
391
AVSD and complex congenital HD treatment?
surgical repair at 3-6 months (blalock-Taussig shunt insertion if cyanosed)
392
Outflow obstruction types?
– aortic stenosis (ass. with mitral stenosis), pulmonary stenosis, coarctation of aorta
393
AS S+Ss?
reduced exercise tolerance, chest pain, syncope, slow rising pulse, carotid thrill, ejection systolic murmur, delayed soft S2; exercise symptoms
394
Treatment aortic stenosis?
balloon valvotomy or replacement
395
PS S+Ss?
asymptomatic, some cyanosis, ejection systolic, RV heave
396
PS treatment?
transcatheter balloon dilation
397
CoA S+Ss and treatment?
worsens over time, ejection systolic, radio-femoral delay; stent may be inserted; arterial duct tissue constricts aorta, blocks LVO; acute circulatory collapse 2 days; S+Ss = sick baby, HF, no femoral pulse, severe metabolic acidosis, cardiomegaly; surgical management
398
Outflow obstruction complications?
HF and shock; ABC, prostaglandin and cardiac centre referral
399
Interruption of arch S+Ss?
no connection between proximal aorta and distal to arterial duct so R-L shunt gives CO; S+Ss = VSD, shock in neonate
400
Interruption of arch treatment?
treat with VSD closure and surgical repair of arch
401
What is hypoplastic left heart syndrome and S+Ss?
left side underdeveloped, CoA, no flow through left side and CV collapse, peripheral pulse weakness
402
Treatment hypoplastic left heart syndrome?
Norwood procedure
403
SVT complications?
most common childhood arrhythmia; HR 250-300, poor CO, pulmonary oedema, HF, hydrops foetalis (oedema/fluid in at least 2 foetal compartments) and intrauterine death; narrow complex tachycadia
404
Treatment SVT?
circ/resp support, vagal manoeuvres, IV adenosine, electrical cardioversion (last line), flecainide/sotalol maintenance; relapse = ablation; complete heart block = pacemaker
405
Cardiac syncope S+Ss?
symptoms in exercise, FH of sudden death, palpitations; acute rheumatic fever = short-lived, multisystem and after group A beta-haemolytic strep, 2-6 weeks = polyarthritis, carditis, erythema marginatum, subcut nodules, sydenham’s chorea, malaise and fever, mitral stenosis (Jone’s diagnostic criteria)
406
Treatment cardiac syncope?
use aspirin and corticosteroids and treat HF with diuretics and ACEi; pericardial effusions = pericardiocentesis, monthly benzathine penicillin prophylaxis
407
Infective endocarditis S+Ss?
sustained fever, malaise, raised ESR, unexplained anaemia, haematuria, clubbing, splinter haemorrhages, oslers nodes, Janeway lesions
408
Diagnosis infective endocarditis?
blood cultures, ECHO, usually strep viridans
409
Treatment of infective endocarditis?
bacterial treatment = high dose penicillin with aminoglycoside (benzylpenicillin with gentamicin) for 6 weeks; prophylaxis = good oral hygiene
410
What is PANDAS?
(paediatric autoimmune neuropsychiatric disorders associated with strep infections) – tics and OCD sometimes anorexia
411
Treatment PANDAS?
abx and risperidone tried
412
Diagnosis dilated CM?
HF and cardiomegaly; diagnose = ECHO
413
Treatment dilated CM?
diuretics, ACEi and carvediol
414
Cardiac S+Ss kawasaki disease?
ECHO = pericardial effusion, myocardial disease, endocardial disease, coronary disease, aneurysm
415
Pulmonary HT S+Ss?
large post tricuspid shunt, high pulmonary flow, low resistance
416
Treatment pulmonary HT?
bosentan, heparin, aspirin or warfarin given so transplant delayed
417
Abnormal findings in antenatal US kidneys?
absence of kidneys, multicystic dysplastic kidney (no functioning tissue and not connected to bladder), Potter syndrome (intrauterine compression from oligohydramnios from low foetal urine – facial deformity, pulmonary hypoplasia, postural deformities)
418
ADPKD childhood S+Ss?
HT; ass with cerebral aneurysms, mitral valve prolapse; cystic dilations of collecting ducts with biliary dysgenesis and periorbital fibrosis
419
What is bladder exstrophy?
bladder through defect in abdo wall
420
What is abnormal caudal migration of kidneys?
horseshoe kidney (silent/obstructive uropathy with/out renal infections), infection, obstruction; can get 2 ureters if premature division of ureteric bud
421
Types of obstruction of urine flow?
pelvi-ureteric, vesicoureteric junction, bladder neck or posterior urethra
422
S+Ss obstruction of urine flow?
can cause dysplastic kidney; posterior urethral valves = progressive bilateral hydronephrosis, poor renal growth, low liquor volume, pulmonary hypoplasia
423
S+Ss UTI?
cystitis = no fever; ½ pts = abnormality, pyelonephritis, scarring leading to CKD; S+Ss = fever, vomiting, lethargy, poor feeding, jaundice, febrile seizure, septicaemia (all in infants, if in children similar to adults)
424
Diagnosis UTI?
urine culture in <3yrs, temp >38; KEEPS organisms; pseudomonas more common in abnormalities/catheters, urine dipstick with nitrites/+ve WCCs
425
Causes of incomplete emptying?
– infrequent voiding, vulvitis, incomplete micturition, obstruction from loaded rectum, neuropathic bladder, vesicoureteric reflux (VUR)
426
What is VUR?
anomaly from laterally displaced ureter enter bladder directly; familial; mild-severe, increased risk of scarring, resolves with age
427
S+Ss atypical VUR?
seriously ill, poor urine flow, abnormal bladder mass, high creatinine, no abx in 48hours, atypical organisms
428
Treatment of urinary obstruction outflow?
MCUG used; infants <3 = IV abx 5-7 days, infants/children with pyelonephritis = oral abx 7 days; cystitis = nitrofurantoin/trimethoprim/co-amoxiclav for 3 days; abx used = amoxicillin and gentamicin or cephalosporin with ampicillin
429
Prevention of urine obstruction outflow?
high fluid intake, complete bladder emptying, treat constipation, good perineal hygiene, probiotic, abx prophylaxis; recurrent/scarring/reflux = urine dipstick, low dose abx prophylaxis, circumcision, anti-VUR, bp check, urinalysis (proteinuria), assess renal function/growth
430
Causes of enuresis?
lack of attention to bladder sensation, detrusor instability, bladder neck weakness, neuropathic bladder (S2-4), UTI, constipation, ectopic ureter (girls dry at night and wet getting up), emotional upset, UTI, polyuria
431
Investigations enuresis?
urine microscopy, US, urodynamic studies, XR and MRI
432
Treatment of enuresis?
star charts, bladder training, pelvic floor exercises, anticholinergics (oxybutynin)
433
What is encopresis?
repeated passage of soiling into wrong area >4yrs (faecal incontinence = soiling due to physical lesion, overflow incontinence from chronic constipation and lose sensation of defecation); voluntary or involuntary
434
Treatment encopresis?
; rule out sexual abuse; enemas, dietary fibre, stool softeners, daily toilet sittings after eating, behaviour therapy (can be psych problems – depression)
435
Causes proteinuria?
orthostatic proteinuria, nephrotic syndrome (corticosteroids; oedema, proteinuria, albumin low, hypercholesteremia sometimes; usually minimal change and sometimes steroid resistant
436
S+Ss proteinuria?
oedema periorbital then general, frothy albumin urine, oliguria), Henoch-Schonlein purpura; S+Ss = periorbital oedema, scrotal/vulval/leg/ankle oedema, SOB (pleural effusion), infection; common in Asians, boys, atopy; renal biopsy if don’t respond to steroids in 4-6wks
437
Risks for proteinuria?
hypovolaemia (IV fluids), thrombosis, infection, hypercholesteremia
438
Treatment of proteinuria?
steroid-sparing therapies (immunomodulators and alkylating agents – cyclophosphamide if don’t work with steroids, cyclosporin = nephrotoxic), diuretics, salt restriction, ACEi, NSAIDs, sometimes unilateral nephrectomy or dialysis
439
S+Ss glomerular haematuria?
glomerular = brown urine, deformed red cells, casts; UTI most common form
440
Glomerular causes of haematuria?
acute GN, IgA nephropathy, familial nephritis
441
Non-glomerular causes haematuria?
infection, trauma, UT/kidneys stones, tumours, SCD, bleeding disorders, hypercalciuria, renal vein thrombosis
442
Investigations of haematuria?
microscopy, calcium/protein excretion, renal US, U+Es, FBC, coagulation screen; biopsy if persistent proteinuria, macroscopic haematuria, abnormal renal function
443
Causes of acute nephritis?
post-infection, vasculitis, IgA nephropathy, antiglomerular basement disease
444
Treatment of acute nephritis?
fluid/electrolyte balance, diuretics, immunosuppression sometimes
445
What is Henoch-Schonlein purpura?
skin rash (buttocks and extensors), arthralgia (knees and ankles), periarticular oedema, colicky abdo pain, glomerular nephritis, have previous resp infection; 3-10yrs boys
446
RFs for CKD in paeds?
heavy proteinuria, oedema, HT, deteriorating renal function, Alport syndrome (X-linked recessive – nerve deafness and ocular defects), polyarteritis nodosa, granulomatosis with polyangiitis, SLE; ANCA
447
CKD treatment?
corticosteroids, plasma exchange and IV cyclophosphamide
448
Causes of HT generally?
renal, cardiac and endo causes
449
S+Ss HT?
vomiting, facial palsies, headaches, hypertensive retinopathy, convulsions, proteinuria, faltering growth, HF; abdo mass US
450
Causes of kidney stones?
phosphate with proteus infection (most common), calcium (high calcium/oxalate)
451
Fanconi syndrome S+Ss?
excessive loss of aas, glucose, phosphate, bicarb, sodium, calcium, potassium, mg, from heavy metals, vit D deficiency or drugs
452
Emergency treatment of HT?
Sodium nitroprusside
453
Acute renal failure causes?
haemolytic uraemic syndrome and acute tubular necrosis (from crush, burn, dehydration, shock, sepsis, malaria)
454
Management acute renal failure?
circ and fluid balance monitored (may need diuretics); US; may need nephrostomy or bladder catheter; good prognosis
455
S+Ss acute renal failure?
Rapid rise in creatinine or development of oliguria/anuria; potassium, creatinine, urea high and calcium, sodium, chloride low
456
RIFLE criteria?
grading = risk, injury, failure, loss of renal function and end-stage renal failure
457
Reasons for dialysis?
conservative management fails, hyperkalaemia, sever hyponatraemia, pulmonary oedema, HT, severe metabolic acidosis, multisystem failure
458
Treatment acute renal failure?
causes; use salbutamol or polystyrene sulfonate resins and calcium gluconate for hyperkalaemia
459
S+Ss haemolytic uraemic syndrome (HUS)?
acute renal failure, microangiopathic haemolytic anaemia and thrombocytopenia, typical with diarrhoea; rare; usually secondary to GI infection with E.coli or shigella; brain, pancreas and heart involved
460
Treatment of HUS?
Eculizumab
461
S+Ss glomerulonephritis?
acute = haematuria and oliguria from autoimmune, also periorbital oedema, fever, GI disturbance and loin pain
462
Complications of glomerulonephritis?
hypertensive encephalopathy, uraemia and cardiac failure/abnormal rhythms
463
Investigations glomerulonephritis?
= FBC, U+E, complement, ANA, ANCA, syphilis, culture, virology (blood and MSU check blood cells); can get poststreptococcal type
464
Treatment for glomerulonephritis?
penicillin but if encephalopathy give nitroprusside
465
Causes of CKD?
congenital dysplastic kidneys, pyelonephritis, recurrent infection, reflux nephropathy, glomerulonephritis
466
S+Ss CKD?
stage 4-5 = anorexia, lethargy, polydipsia, polyuria, faltering growth, bony deformities, HT, proteinuria, unexplained normochromic normocytic anaemia, vomiting
467
Treatment of CKD?
prevent metabolic abnormalities, allow normal growth and maintain current renal function
468
Risks from CKD?
phosphate retention and hypocalcaemia means secondary hyperparathyroidism
469
Treatment for secondary hyperparathyroidism?
improve nutrition, phosphate restriction, bicarb supplements, EPO, GH, dialysis, transplant; prevent renal osteodystrophy (poor mineralisation from renal failure – like rickets/osteomalacia) and anaemia from low EPO
470
Hx for genital disorders?
testosterone, progesterone, phenytoin, aminoglutethimide; past neonatal deaths; penis size, urethra; fused labia; gonads descended (34wks should have)
471
S+Ss inguinal hernias?
– 5% of boys; lump in groin to scrotum (lateral to pubic tubercle), visible on straining, tender and may vomit, can be reduced by taxis (gentle compression in canal) with good analgesia; can sometimes have intestinal obstruction
472
Treatment inguinal hernias?
ligation and division of processus vaginalis; hydrocele = asymptomatic and transilluminate, usually resolve
473
S+Ss varicocele?
15% boys in puberty; more common left side and asymptomatic, dull ache, can be blueish and bag of worms
474
Treatment varicocele?
occlusion of gonadal veins by surgical ligation
475
What are posterior urethral valves?
bladder mucosa folds in male block outflow causing outflow obstruction
476
S+Ss hydrocele?
processus vaginalis; fluid from peritoneal cavity; should stop by age 2; if next to spermatic cord (encysted hydrocele) or wide so hernia then action needed
477
S+Ss undescended testes?
can be palpable but usually incidental finding (external inguinal ring out of scrotum); may be retractile but can be manipulated into scrotum
478
Treatment undescended testes?
orchidopexy = placement of testis in scrotum (cosmetics, lower torsion risk, fertile, reduce malignancy)
479
Torsion causes?
commonly post-pubertal (testicular appendage/Mullerian remnant)
480
S+Ss torsion?
pain groin/lower abdo, redness, oedema of scrotal skin; distinguished from incarcerated hernia
481
Treatment of testicular torsion?
treated soon so no testicular loss (fixation of contralateral testis), analgesia; if in perinatal then loss inevitable
482
S+Ss epididymo-orchitis?
infants and urological/anorectal malformations; doppler US, urine sample; S+Ss = redness, swelling beyond scrotum to thigh, perineum, suprapubic area
483
Treatment of epididymo-orchitis?
analgesia, trauma uncommon but explore and debride/repair if so; think of sexual abuse
484
S+Ss balanoposthitis and treatment?
redness more extensive and purulent discharge, infection bacterial, topical corticosteroids
485
What is phimosis?
balanitis xerotica obliterans gives scarring to glans and urethra; older boys and adults
486
Treatment phimosis?
circumcise, topical corticosteroids and sometimes just wait as normal in most young kids to not be able to retract foreskin
487
What is paraphimosis?
postpuberty and retracted foreskin so glans swells and low blood supply
488
Treatment of paraphimosis?
circumcision and GA
489
S+Ss hypospadias?
failure of development of ventral tissues of penis; features = ventral urethral meatus, ventral curvature of shaft and hooded appearance of foreskin
490
Treatment of hypospadias?
surgery
491
Causes of vulvovaginitis?
vulvovaginitis = from nappy rash and infective from candida
492
S+S vulvovaginitis?
vaginal discharge, fusion of labia minora (irritating)
493
Treatment vulvovaginitis?
Topical corticosteroids if symptomatic
494
S+Ss biliary atresia?
fibrosis and obliteration of biliary tree
495
S+Ss chronic liver failure?
death within 2 years; mild jaundice and pale stools, raised conjugated bilirubin, abnormal LFTs
496
Diagnosis and treatment chronic liver failure?
ERCP and biopsy; palliative surgery (kasai hepatoportoenterostomy) and liver transplant
497
S+Ss choledochal cysts?
cystic dilations of extrahepatic biliary system; jaundice, abdo pain, mass, cholangitis
498
Diagnosis and treatment choledochal cysts?
diagnose = US, MRCP; surgical excision
499
S+Ss neonatal hepatitis syndrome?
low birthweight, faltering growth
500
S+Ss alagille syndrome?
rare AD inheritance; pruritus, faltering growth, triangular facies, skeletal abnormality, HD
501
S+Ss and treatment progressive familial intrahepatic cholestasis?
jaundice, intense pruritus, faltering growth, rickets; transplant needed
502
S+Ss alpha 1 antitrypsin deficiency?
AR inheritance; protein accumulation in hepatocytes; emphysema in adults; neonatal bleeding/jaundice from vit K low; hepatomegaly, splenomegaly, cirrhosis, portal HT
503
S+Ss galactosaemia?
rare, poor feeding, vomiting, jaundice, hepatomegaly (all when fed milk); liver failure, cataracts, developmental delay if untreated; galactose in urine
504
S+Ss viral hepatitis?
= N+V, abdo pain, lethargy, jaundice, hepatomegaly, splenomegaly
505
Treatment viral hepatitis?
treat with ribavirin and pegylated interferon
506
S+Ss acute liver failure?
massive necrosis with liver loss; uncommon but high mortality; infection/metabolic; S+Ss = jaundice, coagulopathy, encephalopathy, hypos, electrolyte disturbance, cerebral oedema, haemorrhages, sepsis
507
Investigations acute liver failure?
LFTs, ALP and ammonia raised, acid-base balance, bg and coagulation monitored
508
Treatment of acute liver failure?
treat the S+Ss; IV dextrose, broad spectrum abx, IV vit K, H2 blocking drugs, fluid restriction
509
Common liver diseases in older children?
common = HBV, HCV, AI hepatitis but exclude Wilson’s and sclerosing cholangitis
510
S+Ss AI and sclerosing cholangitis?
7-10yrs, girls; skin rash, arthritis, haemolytic anaemia/nephritis
511
Diagnosis AI and sclerosing cholangitis?
hypergammaglobulinaemia, positive autoantibodies, low serum C4, histology
512
Treatment AI and sclerosing cholangitis?
prednisolone, azathioprine, SC = ursodeoxycholic acid, optimise nutritional support, liver transplant sometimes
513
Wilson's S+Ss?
– AR inheritance; hepatic dysfunction in childhood, neuropsych with extrapyramidal SEs, renal tubular dysfunction (vit D resistant rickets), Kayser-Fleischer rings (>7), low serum caeruloplasmin and copper
514
Diagnosis Wilson's?
elevated copper in liver
515
Treatment Wilson's?
penicillamine, zinc, pyridoxine (peripheral neuropathy), liver transplant
516
S+Ss congenital hepatic fibrosis and treatment?
>2yrs, hepatomegaly, abdo distension, portal HT, cystic renal disease, NAFLD; liver transplant and weight loss targeted
517
Complications of chronic liver disease?
o Lacking = protein (medium chain triglyceride with milk needed if cholestatic)
o Encephalopathy – protein restricted; causes = GI haemorrhage, sepsis, sedatives, renal failure, electrolyte imbalance, irritable, sleepy, mood change, intellect lower, ammonia high
o Pruritus – loose cotton clothing, moisturising skin, phenobarbital and cholestyramine
o Cirrhosis – secondary to hepatocellular disease/chronic bile obstruction; signs = jaundice, palmar erythema, telangiectasia, spider naevi, malnutrition and hypotonia
518
Investigations for chronic liver disease?
screening for chronic liver disease, upper GI endoscopy, abdo US, liver biopsy
519
Treatment of acute bleeds?
transfusions, H2 blockers; persists = octreotide infusion, vasopressin analogues, endoscopic ligation, scleropathy
520
Causes of ascites?
hypoalbuminaemia, sodium retention, renal impairment, fluid redistribution
521
S+Ss spontaneous bacterial peritonitis?
abdo pain, fever, tenderness, unexplained decrease in renal/liver
522
Reason for liver transplant?
severe malnutrition, complications with management, failure of growth, poor quality of life
523
Diagnoses for malignant diseases?
VMA and HVA useful tumour markers in neuroblastoma, high alpha fetoprotein in germ cell tumours, bone marrow histology for leukaemia or biopsy for solid
524
Treatment for malignant diseases?
chemo = primary curative in ALL, primary/mets before surgery and micromets; allogenic transplant in high-risk/relapsed leukaemia; autologous stem cell support in solid tumours with poor prognosis; with fever and neutropenia = broad spectrum abx; fertility preservation and central venous catheters
525
Examples of opportunistic infections?
PCP, aspergillosis, candidiasis, coagulase-negative staphylococcal infections
526
SEs of chemo?
doxorubicin = cardiotoxicity; cisplatin = renal failure and deafness; vincristine = neuropathy; cyclophosphamide = haemorrhagic cystitis
527
S+Ss leukaemia?
from disseminated disease (BM and organ infiltration by leukaemic blast cells) over weeks; FBC normal, low Hb, thrombocytopenia, malaise, anorexia, N+V, lethargy, bruising, infection and bone pain, lymphadenopathy
528
Investigations leukaemia?
BM examination, clotting screen (for DIC), LP and CXR; B or T cells, normochromic normocytic anaemia; csf
529
Prognostic factors for leukaemia?
age, WCC at presentation, cytogenetics and treatment response; if have Philadelphia chromosome then very high risk
530
Treatment for leukaemia?
before = anaemia, thrombocytopenia, infection, hydration and allopurinol (for renal) should be managed; intense chemo and intrathecal for no CNS relapse, or moderate over 3 yrs; cotrimoxazole for PCP prophylaxis; high chemo and transplant for relapse; induction therapy, then consolidation phase then maintenance
531
Remission of leukaemia?
eradication of leukaemic blast cells and restoration of marrow function
532
Complications of leukaemia?
neutropenic sepsis, hyperuricaemia, cancer elsewhere
533
Management of neutropenic pts?
anything suspect infection; test and treat = piptazobactum (tazocin) +/- gentamicin or imipenem (teicoplanin); usually gram +ve bacteria
534
Types of brain tumours?
always primary, 60% infratentorial, 40% astrocytoma, 20% medullablastoma, 8% ependymoma, 6% glioma, 4%craniopharyngioma
535
S+Ss brain tumours?
high ICP, focal neuro deficits, back pain, peripheral weakness, bladder/bowel dysfunction
536
Investigations and treatment of brain tumours?
MRI, LP and surgery
537
S+Ss lymphomas?
non-hodgkin common in kids = painless lymphadenopathy (usually neck), last months, systemic uncommon, usually T-cell
538
Investigations for lymphomas?
lymph node biopsy, radio assess nodes, BM biopsy, examine CSF
539
Treatment of lymphomas?
combination chemo with/without radio; PET to monitor
540
What are Burkitt lymphomas?
B-cell NHL (more mature than ALL), either endemic (malaria from EBV), sporadic (EBV) and immunodeficient (HIV) associated
541
S+Ss neuroblastoma?
neural crest tissue in adrenal medulla and sympathetic NS; ganglioneuroma to neuroblastoma spectrum; <5yrs; signs = usually abdo mass with adrenal origin (can envelop major vessels and lymph nodes), can have nerve compression from paravertebral, bone pain, BM suppression, weight loss, malaise
542
Treatment neuroblastoma?
surgery (without mets), chemo, autologous stem cell rescue, radio, relapse high
543
S+Ss Wilm's tumour/nephroblastoma?
from embryonal renal (mesoderm) tissue; usually <5; asymptomatic other than large abdo mass but fever, flank pain, anorexia, anaemia, haematuria, HT sometimes; can be associated with beckwith-Wiedemann syndrome (enlargement of most organs), Aniridia (no iris) GU malformations, Retardation; staging from US/CT/MRI
544
Treatment Wilm's tumour?
chemo (vincristine and actinomycin), delayed nephrectomy, 80% cured
545
S+Ss rhabdomyosarcoma?
most common soft tissue in kids; primitive mesenchymal tissue; symptoms = proptosis, nasal obstruction, GU tumours, mets
546
Treatment for rhabdomyosarcoma?
multimodal
547
S+Ss osteosarcoma?
more common than Ewing’s and more common in prepubertal boys; symptoms = limbs, persistent bone pain, use XR, MRI, bone scan, BM and chest CT for mets and diagnosis
548
Treatment osteosarcoma?
combo chemo before surgery and amputation
549
Retinoblastoma S+Ss?
severe visual impairment, if bilateral then hereditary, <3yrs; MRI useful
550
Treatment retinoblastoma?
based on ophthalmology and chemo then laser treatment or radio in advanced
551
S+Ss primary hepatic malignant tumours?
hepatoblastoma or HCC; abdo distension and mass, elevated alpha fetoprotein, most cured
552
What is rhesus haemolytic disease?
RHD-ve mother gives +ve baby and then makes anti-D rhd abs
553
S+Ss rhesus haemolytic disease?
= hydrops fetalis (severe oedematous lunged foetus – need to ventilate with high pressure, find cause, drain ascites, vitamin K to lower haemorrhage, furosemide, limit fluids, 90% die in utero), hypoalbuminaemia, thalassaemia, infection
554
Treatment of rhesus haemolytic disease?
regular US and anti-D titre should be lower <4u/mL and Hb should be above 7g/dL; give mums anti-D IgG, phototherapy and exchange transfusion for below 7g/dL
555
Tropical causes of haemolytic diseases?
malaria, bacteraemia, worms, HIV, low B12, low G6DP, low iron, sickle cell
556
Hb normal values in children?
neonate <140, 1-12 months <100, 1-12yrs <110
557
Causes of reduced red cell production?
(MCV <70fL) – ineffective erythropoiesis (iron deficiency – inadequate uptake, malabsorption (coeliac), blood loss, delay in mixed feeding, asymptomatic unless Hb <70, tiredness, slow feeding; microcytic, hypochromic anaemia, low serum ferritin), abnormal MCV (low in IDA and high folic acid), normal reticulocyte count
558
Treatment of reduced red cell production?
ferrous fumarate syrup
559
Causes of a high MCV?
>100fL – low folate, low B12; absorption, intake, breast milk from veggie, pernicious anaemia
560
Causes of red cell aplasia?
either congenital, transient erythroblasopenia of childhood or parvovirus B19, Diamon-Blackfan = rare
561
Diagnosis red cell aplasia?
low reticulocytes, normal bilirubin, negative Coomb’s, absent red cell precursors on BM
562
Treatment red cell aplasia?
steroids, monthly RBC transfusions, stem cell transplant
563
Causes of haemolytic anaemia?
normocytic) – reduced RBC lifespan; RBCs destroyed in liver/spleen, BM can’t compensate; causes = membrane disorders (spherocytosis – AD inheritance, SEE PHASE 2A NOTES, jaundice, anaemia, splenomegaly, aplastic crisis and gallstones), enzyme disorders (G6PD deficiency – common in central Africa, x-linked, neonatal jaundice, acute haemolysis increased by infection, fava beans, naphthalene, normal blood between episodes), haemoglobinopathies
564
Diagnosis haemolytic anaemia?
hepato/splenomegaly, anaemia, high unconjugated bilirubin, high urinary urobilinogen, high reticulocytes, abnormal RBC shape, positive Coomb’s, high RBC precursors, blood film, autoimmune excluded by Coomb’s
565
Treatment haemolytic anaemia?
oral folic acid, splenectomy sometimes, aplastic crisis = 2 blood transfusion
566
What is haemoglobinopathy?
reduced HbA or low production from deletions; sickle cell anaemia, HbSC and sickle beta thalassaemia; sickle = lower lifespan and stuck in microcirc, HbSS is most severe
567
S+Ss haemoglobinopathies?
anaemia, infection, painful crisis, acute anaemia, priapism (painful and sustained erection), splenomegaly, stroke, cognitive problems, HF, renal dysfunction, gallstones, leg ulcers, psychosocial problems, confusion
568
Treatment haemoglobinopathies?
folic acid; avoid cold, dehydration, high exercise and stress; can use morphine if in a lot of pain
569
Treatment of painful anaemic crises?
oral/IV analgesia, good hydration and exchange transfusion; recurrent = hydroxycarbamide (monitor WBC suppression); can have older retinopathy; beta thalassaemia in India and middle-east; major (need blood with SC iron chelation and desferrioxamine so no iron overload) and intermedia forms
570
What is severe alpha thalassaemia major?
4 alpha globulin deletions; diagnose from liquid chromatography or Hb electrophoresis
571
What is haemolytic disease of the newborn?
abs against blood group antigens; causes = feto-maternal haemorrhage, twin-twin transfusion and blood loss in delivery
572
Causes of anaemia of prematurity?
inadequate epo, reduced RBC lifespan, frequent blood sampling, iron/folic acid deficiency
573
Causes of aplastic anaemia?
BM failure; gives peripheral blood pancytopenia; inherited or acquired (viruses, drugs like sulphonamides or chemo, toxins)
574
S+Ss aplastic anaemia?
anaemia, infection and bruising/bleeding
575
S+Ss Fanconi syndrome?
inherited and most common; S+Ss = short stature, abnormal thumbs, renal malformations, BM failure at 5/6yrs, can become ALL
576
Treatment Fanconi syndrome?
BM transplant
577
Screening tests for bleeding disorders?
screening = FBC, PT, APTT, thrombin time (low fibrinogen), quantitative fibrinogen assay, D-dimers, biochemical screen, don’t forget autoimmune thrombocytopenia
578
S+Ss haemophilia A and B?
x-linked; A (more common) = factor 8 and B = factor 9 deficient; severe = spontaneous bleeding into muscles, joints (arthritis) at end of 1st yr
579
Haemophilia A and B treatment?
recombinant factor 8/9 in bleeding IV, may need to use central venous catheter, desmopressin
580
What to avoid with bleeding disorders?
IM injections, NSAIDs, aspirin
581
What is von Willebrand disease?
von willebrand factor aids platelet adhesion to damaged endothelium and in this case is deficient; type 1 more common
582
S+Ss VWD?
bruising, excessive post-surgery bleeding, mucosal bleeding
583
Treatment of VWD?
desmopressin and if severe = plasma-derived factor 8 concentrate
584
Causes of acquired bleeding disorders?
vit K deficiency (prolonged PT, from inadequate intake, malabsorption, vit K antagonists), liver disease
o Immune thrombocytopenia - pt <150
585
S+Ss acquired bleeding disorders?
bruising, petechiae, purpura, mucosal bleeding; destruction of pts from antiplatelet IgG autoantibodies; exclude if = anaemia, infection, lymphadenopathy, hepatomegaly (SLE)
586
Treatment of acquired bleeding disorders?
oral prednisolone, IV anti-D or IV Ig, rituximab sometimes, splenectomy if all fails
587
What is DIC?
coagulation pathway activation giving diffuse fibrin deposition in microvasc
588
Causes of DIC?
Severe sepsis or shock
589
S+Ss DIC?
bruising, petechiae, haemorrhage, thrombocytopenia, prolonged PT and APTT, low fibrinogen, haemolytic anaemia, low natural anticoagulants
590
Treatment of DIC?
intensive care needed, plasma/cryoprecipitate, vit K
591
Causes of thrombosis in paeds?
most from underlying disorders; congenital thrombophilia disorders = C/S deficiency, antithrombin deficiency, factor 5 Leiden; screen in unanticipated VT with FH of neonatal purpura fulminans
592
Causes of primary ab deficiencies?
primary hypogammaglobulinaemia or bruton’s agammaglobulinaemia
593
S+Ss primary ab deficiencies?
infections, bronchiectasis, sinusitis, failure to thrive, nodular lymphoid hyperplasia, absent tonsils, enteropathy, hepatosplenomegaly, anaemia, arthrology, lymphopenia, low total serum protein; count lymphocytes involved in ab production, FH
594
Treatment of primary ab deficiencies?
ig replacement via iv, use hydrocortisone and antihistamine if reaction; can use stem cells and harmless retrovirus to replace gene
595
Hx for child mental health?
from parents ask how affects child, child and adversity, how did problems start, what was happening at the time, how do people respond, ask what child thinks about problem, any worries, when is it better, what already doing about it, child development
596
Risks for child mental health problems?
anger in fam, parental mental health, bereavement, divorce, intrusive overprotection, lack of parental authority, abuse, emotional rejection, unpredictable discipline, inappropriate responsibilities for child
597
Prevention of child mental health problems?
time spent as a fam (meals – meal refusal = problem), regular exercise, regular sleep (tell child to go to bed and lie there for hour if can’t sleep, night terrors 1.5 hours into sleep), absence of bullying
598
Analysing tantrums?
analysed by ABC (antecedents, behaviour, consequences)
599
Night soiling causes?
abnormal >4yrs; with/without loaded rectum, constipation, inhibition of defecation from fear/punishment, anxiety about toilet
600
Somatic symptoms in paeds?
common and increase with stress, depression, anxiety; abdo pain, headache; older = limb pain, aching muscles, fatigue, neuro; hx identifies causes and use pain-coping skills
601
S+Ss chronic fatigue syndrome?
high levels of subjective persisting fatigue, rapid exhaustion on minimal exercise; sometimes recent infection; myalgia, migratory arthralgia, headache, insomnia, poor conc, irritability normal; stomach pains, scalp tenderness, eye pain, photophobia, depression sometimes
602
Drug abuse in children?
– intoxication, unexplained truancy, mixing with users, high rates of stealing, possession of equipment for drug use, medical complications; solvent abuse = cardiac dysrhythmias, BM suppression, renal failure; ecstasy = hyperthermia, dehydration, death
603
Investigation of drug abuse in children?
urine drug screen, exclusion of medication, dementia
604
Bullous impetigo treatment?
severe blistering and given systemic abx
605
S+Ss malignant melanoma?
congenital pigmented naevi increase risk; macule = small flat area of different colour/texture; papule = small raised lesion; nodule = larger raised and deeper component; purpura = bleeding into skin/mucosa
606
RF malignant melanoma?
prolonged sun (use SPF30), positive FH, melanocytic naevi, far skin, repeated sunburn, hot climate
607
S+Ss albinism?
defect in biosynthesis and melanin distribution; could be oculocutaneous, ocular or partial; pendular nystagmus, photophobia, severe visual impairment
608
What is epidermolysis bulosa?
– rare genetic, blistering skin (after trauma or spontaneously) and mucous membranes; AR more severe (digit fusion, limb contracture)
609
Management of epidermolysis bulosa?
avoid injury and treat infections, nutrition and analgesia
610
S+Ss irritant dermatitis?
most common nappy rash (don’t change enough or diarrhoea); eruption on bum, perineal area, lower abdo, top of thighs; erythematous; not in flexures unless candida
611
Treatment of irritant dermatitis?
protective emollient, severe, change nappies = topical corticosteroids; if candida then topical antifungal and hydrocortisone
612
S+Ss infantile seborrheic dermatitis?
first 3 months; diffuse, red, shiny, erythematous scaly scalp then to face/behind ears; risk of atopic eczema
613
Treatment irritant dermatitis?
mild with emollients and severe with topical corticosteroids/antibac agents
614
S+Ss atopic eczema?
1st year of life; FH, 1/3 get asthma; most resolve by 16; exclude immunodeficiency if severe; S+Ss = pruritus, erythematous excoriated areas that weep and crust, dry skin, lichenification if scratch, flare-ups with staph/strep infections, regional lymphadenopathy
615
What to avoid in atopic eczema?
soap and biological detergents, nails short
616
Treatment of atopic eczema?
emollients, ointments when skin dry, topical corticosteroids, >2yrs short term tacrolimus ointment when steroids fail, occlusive bandages to stop scratching and oral antihistamine, abx with hydrocortisone for infection but if eczema herpeticum then acyclovir
617
Common allergies associated with atopic eczema?
Eggs and cow's milk
618
S+Ss viral warts?
small, skin coloured papules) from HPV disappear over months/yrs
619
Treatment for viral warts?
use cryotherapy and sometimes topical abx, glutaraldehyde solution/salicylic acid and lactic acid paint daily
620
S+Ss scabies?
parasite burrowing into epidermis and severe pruritus after 2-6wks, worse in warm conditions and night, older = fingers, toes, axilla, penis, bum, other fam (treat all fam), analyse skin scrapings
621
Treatment of scabies?
permethrin cream and wash off after 8-12 hours and malathian lotion for 12 hours
622
S+Ss headlice?
scalp itching, may have secondary bacterial infection
623
Treatment headlice?
dimeticon lotion into hair and left overnight, wetcomb with fine-tooth comb
624
S+Ss psoriasis?
usually >2yrs; guttate type most common in kids; attacks 3-4months and recur in next 3-5yrs
625
Treatment psoriasis?
bland ointments, calcipotriol for plaque = coal tar preparations; can develop psoriatic arthritis
626
S+Ss pityriasis rosacea?
acute, benign, viral; rash follows ribs
627
Treatment of pityriasis rosacea?
None but should resolve in 4-6wks
628
What is alopecia areata?
common form of hair loss
629
S+Ss granuloma annulare?
ringed, raised flesh-coloured non-scaling over bony prominences on hands and feet; disappear spontaneously
630
S+Ss acne vulgaris?
1-2yrs before puberty; risk = menstruation and emotional stress
631
Treatment acne vulgaris?
benzyl peroxide, sunshine, topical abx and severe = oral tetracyclines
632
Systemic disease causing skin rashes?
SLE, Hennoch-Schonlein purpura, erythema nodosum, Steven-Johnson syndrome (systemic rash reactions to sepsis/medications – severe bullous form of erythema multiforme starting with URTI)
633
What is urticaria?
flesh-coloured wheals; popular urticarial = delayed hypersensitivity on legs after bite
634
Triggers for TIDM?
triggers for type 1 = enteroviruses, cow’s milk; association with other autoimmune disorders (autoimmune destruction of beta pancreatic cells)
635
S+Ss DM?
triad = polydipsia, polyuria and weight loss, weight loss, infection, poor growth, ketosis; DKA = change in breath, vomiting, dehydration, abdo pain, hypervent, hypovolaemia, drowsiness, coma
636
Diagnosis DM?
symptoms, randomly raised bg >11.1 or 7mmol/l fasting, autoantibodies, type 2 = FH in obese of insulin resistance; monitor blood ketones and check HbA1c 4x per annum
637
Tests for DKA?
intensive educational programme, glucose >11.1, ketones >3.0, U+Es (dehydration), ABG (metabolic acidosis), ECG (t wave change in hypokalaemia),
638
S+Ss DKA?
cerebral oedema (mannitol), weight, infection, hyponatraemia, acidosis, leukocytosis; S+Ss = listless, confused, vomiting, polyuria, polydipsia, weight loss, abdo pain, kussmaul resps, dehydration, shock, drowsy, coma
639
Treatment DKA?
ABC, fluids, IV insulin after 1 hour of fluids, stop insulin after ketones under 1
640
Types of insulin?
human insulin analogues, short-acting soluble human regular insulin, intermediate-acting; can be given as continuous rapid acting; most have long and short; aim for 4-7mmol/L before meals; encourage healthy diet and carb counting
641
Risks increasing consequences of DM?
menstruation, GH, illness, corticosteroids, sex hormones, stress, sugary snacks, infrequent blood testing, illness, exercise, eating disorders, family disruption, inadequate family motivation
642
Conservative management DM?
exercise, alcohol, drugs, anxiety, hot weather
643
S+Ss and treatment hypoglycaemia?
hunger, stomach ache, sweaty, faint, dizzy can lead to seizures and coma; glucose usually but glucagon if severe
644
Hx to ask for DM?
hypos, absence from school, HbA1c, insulin regimen, lipohypertrophy, diet
645
Regular checks for child with DM?
normal growth, BP, renal disease, circ, eyes, feet, screen for coeliac/thyroid, annual flu vaccine
646
S+Ss maturity onset diabetes of the young?
– AD, non-ketotic, children or young-adults; impaired beta cell function and insulin secretion; only single gene defects (unlike DM)
647
Define neonatal hypoglycaemia?
Glucose <2.6mmol/L
648
S+Ss hypoglycaemia?
sweating, irritability, headache, seizures and neuro problems if not fixed; don’t starve infant for >4 hours; check bg if sepsis, prolonged seizure, altered state of consciousness; unknown cause = lab readings, urine
649
Causes of hypoglycaemia?
hepatomegaly could be glycogen store disorder, DM, beta cell tumours, drug-induced, autoimmune, Beckwith syndrome, liver disease, ketotic hypo, hormonal deficiency, congenital error of metabolism
650
Treatment of hypoglycaemia?
don’t overload glucose otherwise cerebral oedema risk, can use IM glucagon
651
Causes of hypothyroidism?
can have severe LD if untreated
o Hypothyroidism = autoimmune; causes = maldescent of thyroid, dyshormonogenesis, iodine deficiency, TSH deficiency, athyreosis, premature, hashimoto’s thyroiditis, down’s, hypopituitarism
652
S+Ss hypothyroidism?
faltering growth, feeding problems, prolonged jaundice, constipation, dry skin, large tongue, goitre, delayed development, hypotonia, delayed puberty, short
653
Diagnosis hypothyroidism?
routine biochemical screen (high TSH but low T4), low Hb, low I uptake
654
Treatment hypothyroidism?
levothyroxine before 2-3wks, lifelong treat
655
Hyperthyroidism S+Ss?
eye signs less obvious, tremor, palpitations, anxiety, tachycardia, low TSH and high T4, exophthalmos, D, weight loss, diarrhoea, sweating, goitre
656
Treatment hyperthyroidism?
carbimazole or PTU (neutropenia SE), beta blockers for anxiety
657
Causes hypoparathyroidism?
usually due to congenital abnormality (DiGeorge syndrome with thymic aplasia, cardiac defects, facial abnormalities), older = autoimmune disorder, Addison’s
658
S+Ss hypoparathyroidism?
hypocalcaemia, constipation, anorexia, lethargy, behaviour change
659
Treatment hypoparathyroidism?
IV calcium gluconate with hypocalcaemia, chronic is with oral calcium and high doses of vit D analogues
660
S+Ss congenital adrenal hyperplasia?
(insufficient cortisol – foetal ACTH production so overproduction of adrenal androgens, virilisation of external genitals, penis enlargement/scrotal pigmentation, salt-losing adrenal crisis (Na and K), tall stature, psychosexual problems, vomiting, dehydration); can give adrenocortical crisis (N+V, abdo pain, lethargy, hypotension; use hydrocortisone, saline, glucose and fludrocortisone)
661
Diagnosis congenital adrenal hyperplasia?
high 17-alphahydroxyprogesterone, low sodium, high potassium, metabolic acidosis, hypos
662
Management congenital adrenal hyperplasia?
lifelong gluco and mineralcorticoids, monitor growth/skeletal maturity and additional hormone replacement
663
S+Ss Addison's?
rare in kids; S+Ss = salt-losing crisis, hypotension, hypos, fatigue, pigmentation
664
Diagnosis Addison's?
hyponatraemia, hyperkalaemia, metabolic acidosis, hypos, ACTH test
665
Treatment Addison's?
crisis (IV saline, glucose, hydrocortisone), parents taught to inject hydrocortisone (reduced height and osteopenia)
666
S+Ss and investigations and treatment of Cushing's?
short, growth failure, red cheeks, hirsutism, bruising, carb intolerance, osteopenia, psych problems, muscle wating and weakness; 24-hour free urinary cortisol high; pituitary adenoma releasing ACTH with transsphenoidal resection; adrenal tumours unilateral
667
Causes of disorders of sexual development?
secondary to virilisation in female from excessive androgens, inadequate androgen action, gonadotrophin insufficiency, ovotesticular DSD
668
What is an inborn error of metabolism?
• Disorder of enzyme reactions (degrade, synthesise, interconvert molecules in cells); disorders of intoxication, energy metabolism, complex organelles
669
S+Ss inborn errors of metabolism?
severe presentation of common illness, diarrhoea, significant metabolic acidosis, unexplained resp alkalosis, hypos, HF, hepatomegaly, unexpected drowsiness, early onset seizures, dysmorphic features, developmental regression, sudden unexplained death
670
Hx for inborn errors of metabolism?
FH of IEoM, sudden unexplained death, epilepsy, LD, consanguinity; examine skin, MSK, eyes; usually AR inheritance
671
Management of inborn errors of metabolism?
medication (symptomatic therapies, specific therapies and enzyme replacement therapy), dietary manipulation (supplying deficient product, preventing accumulation of toxic substrate, prevention catabolism, ketogenic diet); more likely if acidosis too much with clinical picture, abnormalities persist even when managed (raised anion gap – usually 10-16mmol/L)
672
S+Ss infection for those with inborn errors of metabolism?
common trigger; ammonia measured if unexplained encephalopathy, resp alkalosis, recurrent vomiting, unexplained severe illness, unexplained seizures
673
Treatment of inborn errors of metabolism with infection?
stop feeds, 10% dextrose, IV ammonia scavengers and arginine
674
What is a glycogen storage disorder?
hepatic (hypos), muscular, cardiac; degradation in enzymes needed for glycogen storage and synthesis
675
S+Ss glycogen storage disorders?
poor feeding, hepatomegaly, raised lactate, neutropenia 1b, stiffness and myalgia after exercise
676
Types of glycogen storage disorders?
von gierke, pompe’s, cori, Anderson, mcardle, hers, tauri
677
Diagnosis glycogen storage disorders?
= low levels of lactate and pyruvate in venous blood post exercise and low phosphorylase muscle staining
678
Treatment glycogen storage disorders?
= no extreme exercise and glucose/fructose can help
679
What is a lysosomal storage disorder?
can’t break down chemical (accumulate);
680
Diagnosis lysosomal storage disorder?
urinary glycosaminoglycan screen, oligosaccharide screen, WCC testing
681
S+Ss lysosomal storage disorder?
supportive treatment; most common = Gaucher disease and familial hypercholesteraemia is most common inherited
682
Treatment lysosomal storage disorder?
low fat diet, statin, ezetimibe
683
S+Ss PKU?
mutation of phenylalanine hydroxylase gene; mental impairment, fair hair, fits, eczema, musty urine
684
Treatment PKU?
expert help and diet low in phenylalanine but high in tyrosine
685
General MSK leg problems in kids?
• Most kids have tibiae bowing but if pathological then rickets; varus usually resolves; flat feet common in hypermobile and toddlers (if painful then tendo-Achilles contracture or JIA); toe-walking common in kids
686
In-toeing causes of abnormal gait?
metatarsus varsus (from being flat-footed), medial tibial torsion and persistent anteversion of femoral neck
687
Causes of abnormal posture?
talipes (club foot – inverted and supinated, equinovarus = complication) from intrauterine compression, passive exercises useful, can be bilateral, calf and leg smaller
688
Treatment of abnormal posture?
plaster cast and bracing
689
What is vertical talus?
foot is stiff and rocker-bottom shape; diagnose with XR and surgery needed
690
What is talipes calcaneovalgus?
dorsiflexed and everted foot
691
Tarsal coalition definition?
bones of foot more rigid as more fused; surgery
692
S+Ss DDH (developmental dysplasia of the hip)?
dysplasia, subluxation and dislocation of hip; limb or abnormal gait
693
S+Ss scoliosis?
lateral curvature in frontal plane of spine; mild, pain-free, cosmetic but can cause CV failure
694
Causes scoliosis?
idiopathic, congenital structure defect, neuromuscular imbalance, connective tissue disorder
695
Causes of torticollis?
sternocleidomastoid tumour; mobile, non-tender nodule, restriction in head-turning; later causes = muscular spasm from ENT infections/spinal tumour/C-spine arthritis
696
S+Ss painful limb, knee, back?
growing pains common, 3-12 yrs, symmetrical limb pain, after start of day, physical activity and exam normal
697
Causes and S+Ss hypermobility?
MSK pain after exercise; local or general; causes = chromosome abnormalities, collagen disorders; S+Ss = hyperaesthesia, allodynia, bizarre posturing, if diffuse then widespread pain, disturbed sleep, exhausted in day
698
What is osteomyelitis?
infection of metaphysis of long bones; distal femur and proximal tibia; spread from staph, strep, H.influenzae and sometimes TB in immunocompromised
699
S+Ss osteomyelitis?
painful, immobile limb, febrile illness, infection is erythematous and warm, blood culture positive, high CRP and WCC
700
What to rule out for bone pain, swelling and fx?
osteoid osteoma = benign affecting adolescents in long bones in leg and spine (pain at night improves with NSAIDs)
701
What is Osgood-Schlatter disease S+Ss?
osteochondritis of patellar tendon in adolescent males; physically active, knee pain after exercise, localised tenderness, swelling
702
Treatment of Osgood-Schlatter disease?
reduce exercise and physio, knee immobiliser splint
703
What is chondromalacia patellae?
softening of articular cartilage of patella in adolescent females
704
Treatment of chondromalacia patellae?
physio
705
Osteochondritis dissecans S+Ss?
persistent knee pain in physically active adolescent; tenderness over femoral epicondyles; from avascular necrosis
706
Treatment osteochondritis dissecans?
rest and quad exercises
707
Things to rule out with back pain?
if in younger then pathological (mechanical, tumour, vertebral osteomyelitis/discitis, spinal cord/nerve entrapment and Scheuermann disease, spondylosis and CRPS)
708
S+Ss transient synovitis?
acute hip pain with decreased movement and referred knee pain, 2-12yrs with virus, can develop to Perthes disease
709
Treatment transient synovitis?
bed rest and skin traction
710
What is Perthes disease?
avascular necrosis of capital femroal epiphyses of femoral head from blood supply interruption then revascularisation, mainly boys
711
Diagnosis perthes disease?
bone scan, MRI
712
Treatment pertes disease?
rest, physio, plaster casts, surgery; slipped capital epiphyses need to be treated before avascular necrosis, restricted abduction and internal hip rotation
713
S+Ss acute arthritic pain in kids?
pain, swelling, heat, redness, restricted movement
714
Causes of arthritis in kids?
reactive arthritis is most common form (ankles, knees after extra-articular infection), enteric bacteria in children with virus and STIs in adolescents; septic, JIA, HSP
715
Septic arthritis S+Ss and diagnosis?
<2yrs; common = staph aureus; S+Ss = erythematous, warm, acutely tender joint with lack of movement, infants hold limb still, joint effusion detectable, WCC and CRP high, blood cultures, US shows effusion, joint aspirate = diagnostic
716
Treatment septic arthritis?
IV abx, washout and surgical drainage
717
S+Ss JIA?
common chronic inflammatory joint disease in kids; persistent joint swelling >6wks in <16 with no infection; S+Ss = gelling (stiffness after rest), morning joint stiffness and pain, intermittent limp, behaviour/mood deterioration, antinuclear factor may be present
718
Complications JIA?
chronic anterior uveitis (low sight from cataract), flexion joint contracture, growth failure, anaemia of chronic disease, delayed puberty, osteoporosis and amyloidosis
719
Treatment JIA?
NSAIDs, analgesics, joint injections, methotrexate, systemic corticosteroids, cytokine modulators
720
S+Ss hennoch-Schonnlein purpura?
most common vasculitis of kids; S+Ss = purpuric rash on legs and bum, abdo pain (use steroids), haematuria, proteinuria, arthralgia, severe nephropathy sometimes, scrotal oedema sometimes and sometimes intussusception
721
S+Ss juvenile dermatomyositis?
malaise, progressive weakness, facial rash, muscle pain, resp failure and aspiration pneumonia can happen
722
S+Ss achondroplasia?
AD inheritance; features = short stature, large head, frontal bossing, depression of nasal bridge, lumbar lordosis and hydrocephalus
723
S+Ss thanatophoric dysplasia?
stillbirth, large head, short limbs; XR and antenatal US
724
S+Ss arthrogryposis?
stiffness and contracture of joints, marked flexion contractures, muscle atrophy over joints; association with oligohydramnios
725
Treatment arthrogryposis?
physio and correction of deformities
726
Osteogeneis imperfecta S+Ss (type 1 and 2)?
disorder of collagen metabolism; S+Ss = bone fragility, bowing, frequent fx; type 1 = AD, fx in kids and blue sclera, less severe, treat with bisphosphonates; type 2 = severe
727
S+Ss osteopetresis?
bones dense and brittle, faltering growth, recurrent infection, hypocalcaemia, anaemia, thrombocytopenia
728
Treatment osteopetresis?
BM transplant
729
S+Ss and complications Marfans?
AD, tall stature, long thing digits, hyperextensible joints and eye lenses, CV aneurysms and valvular incompetence
730
Types of febrile seizures?
fever and no intracranial infection; small chance of epilepsy (focal, generalised, tonic/conic [grand mal – limbs stiffen which is clonic and then jerk which is tonic], absences [brief 10 sec pauses, unaware], infantile spasms/west syndrome [clusters of head nodding and arm jerks – use prednisolone])
731
Causes of febrile seizures?
hypoxic-ischaemic encephalopathy, infection, intracranial haemorrhage, CNS lesions, metabolic disturbance/disorders, withdrawal, kernicterus (rare brain damage from jaundice), idiopathic
732
S+Ss febrile seizures?
toddlers have blue breath holding spells (after anger/crying), blue, stiff, limp, apnoea, lip-smacking, limb-cycling, eye-deviation and then recover, reflex asystolic syncope after sudden surprising pain (stop breathing, pale, stiff, brief convulsions, rapid recovery), EEG, lasts <15 min, >1 in 24 hrs
733
Treatment of febrile seizures?
ketogenic diet, vagal nerve stimulation, surgery, treat causes, empirical abx, IV access for invest, cerebral function analysis monitoring; prolonged seizure 3-5 min = phenobarbital and if not then phenytoin, others = midazolam, clonazepam, paraldehyde, lorazepam, diazepam; treat fever with antipyretics, parental education
734
What is a positive gower's sign?
proximal weakness and inability to stand unaided from supine
735
Emergency treatment of epilepsy?
0-5min = ABC, 5-15 = lorazepam or buccal midazolam, 15-20 = phenytoin or phenobarbital and call PICU/anaesthetist, 20-40 = PICU
736
Drug management of epilepsy?
carbamazepine, sodium valproate, ethosuximide, lamotrigine, vigabatrin, levetiracetam, diet, education
737
S+Ss reflex anoxic attacks?
paroxysmal, self-limiting, asystole, fear and pain triggers; S+Ss = hypotonia, rigidity, upward eye deviation, clonic, incontinent urine; drugs rarely needed
738
S+Ss panayiotopoulos syndrome?
benign focal seizure disorder, 5yrs peak, autonomic symptoms; vomiting and eye deviation before seizure, at night; no drugs as recover in 2yrs
739
What is ohtahara syndrome?
tonic spams with/out clustering
740
Treatment of ohtahara syndrome?
chloral hydrate
741
What does ohtahara syndrome develop into?
west syndrome then lennox-gas-taut syndrome
742
S+Ss rolandic?
benign, brief, infrequent, unilateral facial/oropharyngeal and rarely speak; no treatment needed
743
S+Ss migraine?
severe bilateral or frontal 1-48 hours, N+V either 2 of photophobia, phonophobia, visual, sensory aura; aggravated by activity, daily then chronic, CHOCOLATE aggravators
744
Treatment migraine?
paracetamol, ibuprofen, domperidone for nausea and sumatriptan if doesn’t work
745
Prophylaxis for migraine?
avoid triggers, pizotifen if not then propranolol and amitryptilline
746
What is craniostenosis and its complications?
premature closure of skull’s fibrous sutures by ossification (should be 3-9 months for frontal and 22-39 months for rest – can mean brain diesn’t have enough growth room = high ICP, sleep loss, eating problems, visual loss, low IQ)
747
Investigations for myopathy?
plasma CK, muscle biopsy, DNA testing, US/MRI muscles
748
S+Ss spinal muscular atrophy?
AR, degeneration of anterior horn cells; S+Ss = tongue fasciculation, symmetrical flaccid paralysis, absent deep tendon reflexes, intercostal recession, weakness of bulbar muscles, death from resp failure in 12 months
749
S+Ss dermatomyositis?
5-10yrs; S+Ss = symmetrical muscle weakness, sometimes with pharynx, purple rash on eyelids, periorbital oedema
750
Treatment dermatomyositis?
physio, corticosteroids, immunosuppressants
751
S+Ss Freidrich ataxia?
AR; S+Ss = worsening ataxia, dysarthria, wasting in lower limbs, absent reflexes, pes carvus, kyphoscoliosis, DM, cardiomyopathy, death at 40-50yrs
752
S+Ss ataxia telengiectasia?
AR condition of DNA repair; delay in motor movement, complex eye movement disorder, cerebellar ataxia, dysarthria, susceptibility to infection, malignant disorder, progressive pulmonary disease
753
What is anencephalopathy?
failure of development of cranium and brain (myelocele); most stillborn
754
Types of myelodysplasia?
neuroectoderm defect (no fused tube = myelocele, double neural tube = diplomyelia, herniation through bony defect = meningocele and meningomyelocele if cord as well)
755
Prevention of myelodysplasia?
folic acid to mother
756
What is spina bifida occulta?
failure of vertebral arch fusion
757
S+Ss meningocele?
variable paresis of lower limb, muscle imbalance, sensory loss, bladder/bowel denervation, scoliosis, hydrocephalus
758
Treatment of meningocele?
physio, indwelling catheter, checks for HT/RF/UTI, laxatives, suppositories, surgical treatment
759
Treatment of hydrocephalus in kids?
cranial US in young and CT/MRI in kids with head circ, use a ventriculoperitoneal shunt
760
S+Ss type 1 neurofibromatosis?
AD, mutation in neurofibromin-1 gene; S+Ss = >6 café-au-lait spots, neurofibroma on periphery nerves, axillary freckling, optic glioma, bony lesions, 1st degree relative with condition; sometimes megalencephaly with LD and epilepsy
761
S+Ss type 2 neurofibromatosis?
AD, present in adolescence, bilateral acoustic neuromata, present with deafness and cerebellopontine angle syndrome, multiple endocrine neoplasia syndromes
762
S+Ss tuberous sclerosis?
AD, mutations in TSC1/2 genes; S+Ss = depigmentation patches, roughened skin over lumbar spine, angiofibromata (over nose-bridge), developmental delay, epilepsy, LD, fibromata under nails, dense white areas on retina, rhabdomyata on heart, angiomyolipomas, polycystic kidneys, lung cysts
763
S+Ss Sturge-Weber syndrome?
sporadic, port-wine stain in trigeminal distribution, epilepsy, LD, contralateral hemiplegia, ophthalmic nerve always involved
764
Treatment Sturge-Weber syndrome?
laser treatment to reduce ipsilateral glaucoma risk
765
S+Ss foetal alcohol spectrum disorder?
microcephaly, short palpebral fixtures, hypoplastic upper lip, small eyes, low IQ, cardiac mmalformations
766
S+Ss x-linked adenoleukodystrophy (ALD)?
peroxisomal defects and neonatal (feeding problems, seizures, hypotonia), X-linked (adrenal glands, brain cells and myelin), childhood cerebral (boys 4-12yrs, low academic performance, regression, ataxia, adrenal insufficiency), adrenomyeloneuropathy (slowly progressive spastic paraparesis, dorsal column sensory disturbance)
767
HEADS for taking a psychosocial hx in adolescents?
Home life, Education, Activities, Driving drugs and diet, Sexual health sleep suicide and safety
768
What are the 4 points of child rights?
survival rights (food, shelter, access to healthcare), developmental rights (achieve full potential in education, play, thoughts, religion), protection rights (against all forms of abuse), participation rights (active role in the community)
769
Top 5 causes of death in children worldwide?
pneumonia, diarrhoea, HIV, malaria and measles
770
Systems review in child?
general rashes, fever; resp (cough, wheeze, breathing problems); ENT (throat infections, snoring, noisy breathing); CV (murmur, cyanosis, exercise tolerance); GI (D+V, constipation, abdo pain); GU (dysuria, frequency, bed-wetting); neuro (seizures, headaches, abnormal movements); MSK (gait, limb pain, swelling)
771
What is fogg's test?
walk on heels, inside and outside of feet to assess gait
772
Give the primitive reflexes in infants?
moro (sudden head extension causes extension then arm flexion – similar to startle reflex but this dwindles after multiple times), grasp, rooting (head turns to stimulus when touches near mouth), stepping response, asymmetrical tonic neck reflex (when lying supine head turns to side and arm outstreteched)
773
Give the postural reflexes in infants?
labyrinthine righting (head moves opposite to way head tilted), postural support (when held upright legs take support), lateral propping (arm extends to way child falls), parachute (arms extend when held upside down)
774
What is developmental screening?
checking children at set ages for milestones and formal process
775
What is developmental assessment?
detailed analysis of particular areas if development to follow up any concerns for diagnosis and formulating a management plan
776
What is the healthy child programme?
screening tests, development reviews, health promotion from 0-19yrs
777
What is optoacoustic emission?
use earphone to produce a sound from the ear if cochlear working
778
What is auditory brainstem response audiometry?
computer analysis of EEG from auditory stimuli
779
What is visual reinforcement audiometry?
Turn head to stimulus with different frequencies
780
What is performance and speech discrimination testing?
Can visibly understand the content of what is being said (asked to pick up a toy etc)
781
Give the gross motor function classification?
level 1 = walks without limitations, 2 = walks with limitations, 3 = use handheld mobility advice, 4 = self-mobility with limitations (may need powered mobility), 5 = in manual wheelchair
782
What is amblyopia?
potentially permanent loss of visual acuity in eye/lazy eye
783
What is involved with the common assessment framework (for special needs)?
multidisciplinary sharing of diagnosis, assessment of functional skills, provision of therapy, regular review, coordinated approach to care
784
Flowchart progression for evidence based paeds practice?
Frame question, search for evidence, appraise the evidence and make a decision and evaluate your performance
785
S+Ss compensated shock?
tachypnoea, tachycardia, low skin turgor, sunken eyes and fontanelle, delayed cap refill, mottled/pale/cold skin, core-peripheral temp gap >4degrees, decreased urine output
786
S+Ss decompensated shock?
acidotic breathing, bradycardia, confusion, blue peripheries, absent urine output, hypotension
787
S+Ss sepsis?
fever, tachycardia, tachypnoea, purpuric rash (meningococcal shock), poor feeding, irritable, focal infection, multi-organ failure, shock
788
Causes of life threatening events?
infections (RSV and pertussis), GORD, seizures, upper airway obstruction
789
Investigations of life threatening events?
blood glucose, blood gas, O2 sats, cardioresp monitoring, EEG, oesophageal pH, barium swallow, FBC, U+Es, lactate, urine (culture, toxicology, microscopy, metabolic), ECG, CXR, LP
790
What chelating agents used for lead posioning?
D-penicillamine or EDTA if severe
791
2 types of birth defects?
single-system or sequence
792
4 causes of dysmorphology?
malformation (primary structural defect in development of organ), deformation (abnormal uterine force distorting normal formed structure), disruption (destruction of part that was formed normally), dysplasia (abnormal cells/organisation of tissue)
793
Genetic testing methods?
PCR, FISH, aCGH, GWAS
794
When to consider DOPE and what it is?
When intubating newborn isn't working; displaced airway, obstructed airway, patient (airway disorders, shock, birth asphyxia etc), equipment failure
795
What to give all newborns to stop haemorrhaging?
Vit K
796
What is the guthrie/heel prick/newborn screening test for in newborns?
biochemical screening from blood; for checking if have phenylketonuria, hypothyroidism, haemoglobinopathies, CF, MCAD
797
Why is hypothermia a problem in preterm infants and how is it prevented?
thinner walls, less fat, large SA to V ratio; put in incubators, cover and keep dry
798
What is the cause of transient tachypnoea in the newborn?
delay in resorption of lung liquid
799
How to prevent left to right shunting in persistent pulmonary hypertension of the newborn?
use NO or sildenafil to dilate vessels
800
Main cause of pulmonary hypoplasia in newborn?
Diaphragmatic hernia
801
Neonatal seizures S+Ss?
unstimulated, repetitive, rhythmic clonic movements
802
Neonatal seizures treatment and investigations?
use EEG and check for hypoglycaemia/meningitis, head US, use MRI to check for stroke
803
What is the fastest growth period?
Foetal
804
What is failure to thrive?
Inability to grow in infantile growth stage
805
What is craniosynostosis?
premature fusion of the skull sutures leading to head shape distortion
806
When does the brain dveelop the most?
Last trimester of pregnancy and first 2yrs of life
807
Problems with breastfeeding?
o Can transmit drugs or infection (hep B, HIV), jaundice, less flexible, vit K if breast milk is deficient
808
Mechanism for breastfeeding?
baby uses rooting, sucking and swallowing reflex, tactile receptors in nipple activated, hypothalamus sends impulses to anterior (prolactin secretion for milk secretion from cuboidal cells) and posterior pituitary (oxytocin for contraction for ‘let down’ reflex in myoepithelial cells)
809
When should be weaning of pureed food be introduced?
After 6 months (don't give wheat, eggs, fish) and no honey til 1yr to prevent infantile botulism
810
Causes of failure to thrive?
organic (impaired suck/swallow reflex, cleft palate, Crohn’s, chronic renal failure, CF, liver disease, coeliac, cow’s milk intolerance, chromosomal disorders) or non-organic (psychosocial and environmental deprivation), undernutrition for both
811
History taking in failure to thrive?
diet, feeding details, energy levels, diarrhoea, vomiting, cough, premature/IUGR, growth of other family, development normal, psychosocial, HF, dysmorphia
812
How is vit D3 activated?
hydroxylated by liver from oral/sun intake or from bone by parathyroid hormone
813
Earliest sign of rickets?
craniotabes (ping pong sensation in skull)
814
Pathophysiology of vit A deficiency?
aka retinol, complication of fat malabsorption
815
S+Ss and complications of Vit A deficiency?
S+Ss = rare other than can’t adapt to dark light; complications = eye damage (xerophthalmia), night blindness from corneal ulceration and scarring, susceptible to infection
816
S+Ss Meckels diverticulum?
ectopic gastric mucosa/pancreatic tissue, S+Ss = severe rectal bleeding, volvulus, diverticulitis
817
Aetiology and S+Ss volvulus?
mesentery unfixed at duodenojejunal flexure/ileocaeal region and obstruction with/out compromised blood supply, dark green bilious vomiting, abdo pain from peritonitis/ischaemia
818
Treatment for diarrhoea in kids?
fluids (isotonic), abx (don’t try to use anti-diarrhoea/anti-emetics) then give good nutrition post-infection
819
SS and aetiology of coeliacs?
AI against gluten to lead to villous atrophy, anaemia, failure to thrive and abdo distension
820
Difference between UC and crohns?
only after ileum and crohn is skip lesions and anywhere from mouth to anus
821
What is used to treat EBV in kids if not serious?
Amoxicillin/ampicillin with symptomatic management (airway management)
822
TB S+Ss in kids?
fever, malaise, anorexia, weight loss, focal infection signs
823
Tests for TB?
Mantoux, interferon gamma release assays (best one) and tuberculin tests
824
RIPE treatment for TB?
rifampicin, isoniazid, pyrazinamide, ethambutol
825
Vaccine prevention TB?
BCG
826
Sinusitis in paeds S+Ss?
mainly paranasal sinuses with tenderness, swelling
827
Treatment for sinusitis?
acute give abx, analgesia and topical decongestants
828
Indications for tonsillectomy or adenoidectomy?
recurrent tonsillitis, OSA, peritonsillar abscess
829
Differences between croup and epiglottitis?
croup over days rather than hours, no coryza in epiglottitis before, severe coughing/barking, can’t drink in epiglottitis, drooling in epiglottitis, higher fever and more unwell in epiglottitis, harsher stridor in croup
830
Vaccines against the pathogens causing pneumonia?
Prevenar and Hib
831
What is global developmental delay in children?
delay in more than 2 areas of development – mild, moderate and severe determined against children of their age
832
What test and why would you do in a boy 18 months old and not walking?
CK for muscular dystrophy
833
Dx diagnosis of testicular torsion?
testicular appendage/Mullerian remnant is torsion of appendix testis and mimics testicular torsion
834
Dx of lumps in neck?
thyroglossal cyst on front of neck (surgical removal), cervical lymph nodes swelling (viral infection but if >2cm for 2wks then maybe lymphoma etc), brachial fistula
835
What is omphalitis?
infection of umbilicus, can form sepsis quite easily so needs immediate treatment
836
Consequences of tricuspid atresia?
mixing of blood and difficult to treat surgically as right atria not working, relies on venous pressure to pump blood to lungs, palliation, chronic cyanosis that worsens
837
Tests of kidney function in children?
plasma creatinine conc, eGFR, inulin/EDTA filtration rate, plasma urea conc
838
Consequences of acute nephritis?
hypertension, oedema, proteinuria, haematuria, decreased urine output, volume overload
839
Normal conditions in young boys in the genitals?
preputial adhesions (foreskin partially adherent to glans) and trapped epithelial squames looking like white pearls under foreskin
840
Indications for circumcision?
recurrent balanoposthitis, recurrent complicated UTIs, phimosis
841
Treatment for vulvovaginitis and fusion of labia minora firstline?
Topical oestrogen
842
Warning signs for jaundice in neonates needing treatment?
• Prolonged neonatal jaundice (with pale stools, dark urine, bleeding tendency, failure to thrive)
843
Main S+Ss of liver failure?
encephalopathy, jaundice, epistaxis, pale stools, dark urine, bleeding tendency, failure to thrive, ascites, hypotonia, peripheral neuropathy, rickets, varices of portal hypertension, spider naevi, muscle wasting, bruising, petechiae, splenomegaly, hypersplenism, hepatorenal failure, liver palms, clubbing
844
Diagnosis of billiary atresia?
operative cholaniography
845
How to treat billiary atresia?
Kasai procedure/hepatoportoenterostomy
846
Causes of chronic liver disease?
hep B and C, AI hepatitis, nitrofurantoin/NSAIDs, IBD, primary sclerosing cholangitis, Wilson’s, alpha 1 antitrypsin, CF, neonatal liver disease, bile duct lesions
847
Treatment of ascites?
Diuretcis and fluid and sodium restriction
848
Treatment of spontaneous bacterial peritonitis?
Broad spectrum abx
849
Vitamins given in liver failure?
ADEK
850
3 indicators of malignancy in general?
localised mass, disseminated disease (bone infiltration etc), pressure from mass on local structures
851
SEs of chemo?
Allopecia, GI damage, N+V
852
Name of the cells in Hodgkin's lymphoma to diagnose?
Reed-sternberg
853
Most common way retinoblastoma picked up?
White reflex instead of red reflex
854
S+Ss of langerhans cell histiocytosis?
technically not cancer; S+Ss = seborrheic rash, widespread soft tissue infiltration, bone pain/swelling, diabetes insipidus
855
5 factors involved in blood clotting homeostasis and how they do it?
coagulation factors (vessel injury and from liver), coagulation inhibitors (stop widespread coagulation), fibrinolysis (limits fibrin deposition to just site of injury), platelets (aggregate at site of injury for fibrin), blood vessels (initiate and limit coagulation, intact release prostaglandin I2 and NO for vasodilation and inhibition platelet aggregation; damaged releases tissue factor and procoagulants [VWF and collagen])
856
Are haemangiomas ok?
not good in mouth as obstruction, eye and use beta blockers
857
What are mongolian blue spots (on bottom)?
not bruises btu fine and should go away
858
What is coxsackie?
hand, foot and mouth disease
859
Molluscum contagiosum S+Ss?
red warts all over skin
860
What causes impetigo and therefore what should you use to treat it?
from staph aureus and use flucloxacillin
861
DKA CO2 and pH and HCO3 values?
pH = 7.06, CO2 = 2.8 and HCO3 = 13
862
What happens after 6 months of ITP?
Becomes chronic and should screen for SLE
863
What age do babies get upset about removal from their main caregiver?
6-8 months
864
What is the triphasic acute separation reaction?
mounting fear mother doesn’t reappear; then child becomes withdrawn from play, food and speech; child eventually cheers up but now indifferent to the mother (detachment)
865
What does the PATHOS mneumonic stand for in assessing suicide risk?
Problems for longing than a month?, Alone in the house at the time?, plan the OD for longer than Three hours?, feeling HOpeless about the future?, feeling Sad most of the time before OD?
866
Main psych treatment for emotional and behavioural problems?
explanation and reassurance, counselling of child/parents, parenting groups, behavioural therapy, family therapy, cognitive therapy, individual or group dynamic psychotherapy
867
What is a collodion baby and how to treat?
baby comes out dry and scaly skin; use emollients and moisturisers
868
S+Ss ringworm?
when dermophyte fungi invade dead keratinous skin, scalp from dogs and cats, UV light can show yellow infected hairs
869
Treatment ringworm?
Topical antifungals
870
What is pediculosis?
Headlice
871
Long-term risks from diabetes?
stunted growth, delayed puberty, HT, renal disease, retinopathy, peripheral neuropathy (feet), type 1 associated with coeliac, thyroid disease and other AI diseases
872
Definition of hypoglycaemia?
BG below 2.6mmol/L
873
Main cause of hyperthyroidism in children?
Grave's disease
874
Causes of failure of treatment?
ADECB = adherence, diagnosis, environment, choice of drugs/device, bad disease
875
Definition of UTI?
at least 10^5 organisms in urine
876
Types of strabismus?
eye deviation/strabismus = esotropia (eye deviates in), exotropia (eye out), hypertropia (up) and hypotropia (down); others = deviation when covered esophoria, exophoria, hyperphoria, hypophoria
877
What is anisometropia?
difference in refractive error (associated with strabismus and amblyopia)
878
How to detect a strabismus?
Corneal reflective test, cover test using corneal reflection
879
Treatment of amblyopia?
refractive adaptation (glasses), occlusion of the better seeing eye, atropine drops to paralyse the good eye
880
Management of strabismus?
glasses, orthoptic exercises, prisms, surgery or botox in extraocular muscles
881
What are the three factors a disability is defined by?
functioning, activity and ability to participate
882
WHODAS 6 domains of functioning covered in assessing a disability?
cognition, mobility, self-care, social, life activities, participation
883
Problems with prematurity?
chronic lung disease of prematurity, inadequate neural development (LD), apnoea of prematurity (baby forgets to breath, give phosphodiesterase inhibitor and caffeine, CPAP), ventricular haemorrhage (not usually long-term consequences unless massive), cystic periventricular leukomalacia (worst type of premature brain injury – end up with some kind of plegia [hemi, para, tetra]), 22-25 wks very high likelihood of death
884
Who automatically has parental responsibility?
• Unless married, the mother has parental responsibility of the child’s care
885
Factors to cover when thinking about when to apply fraser guidelines (and Gillick competency)?
girl understand advice, cannot persuade to tell parents about contraceptive advice, likely to keep having sex, unless she has contraceptive advice physical and mental health suffer, best interests to give contraceptive advice
886
Cause of transient tachypnoea of the newborn?
C section
887
Origin of cause for inspiratory stridor?
Laryngeal
888
Origin of cause for biphasic stridor?
subglottis/trachea
889
Origin of cause of expiratory stridor?
bronchi
890
ENT causes of stridor?
laryngomalacia, cysts, papilloma, haemangiomas, clefts, post intubation subglottis stenosis, tracheobronchomalacia
891
Diagnosis of OSA?
Polysomnography and management from hx and examination (large adenoids need removal with tonsils)
892
Which side does foreign body tend to fall into in lung?
Right side
893
Red flag sign causes for high fever?
Pneumonia, UTI, bone/joint infection, kawasaki, flu, meningitis and meningococcal septicaemia
894
S+Ss meningococcal sepitcaemia?
Fever, rigors, mottled, rash (non-blanching), bulging fontanelle, febrile, tachypnoea, tachycardia, cold peripheries, delirium, arthralgia
895
What is a vesicle?
blistering like in chicken pox/herpes simplex
896
What is a pustule?
pus in a vesicle
897
What is petechiae?
smaller spots of purpura (below 2mm)
898
What is urticaria?
raised, itchy red rash usually from reaction and looks like nettle sting
899
What is eczema?
dry itchy skin and can be red
900
What is the mnemonic and what it stands for for emergency management of a seriously ill child?
ABCDENT TT - airway, breathing, circulation, ENT, temperature, tummy
901
Thalidomide ADR?
fetal congenital abnormalities
902
Surfactant ADR?
pulmonary haemorrhage
903
Chloramphenicol (eyedrops abx) ADR?
grey baby syndrome
904
Ceftriaxone ADR?
calcium precipitation
905
Sulphonamides ADR?
kernicterus
906
Aniline dye from nappies ADR?
methaemoglobinaemia
907
Sodium valproate ADR?
liver toxicity
908
Propofol ADR?
metabolic acidosis
909
Lamotrigine ADR?
serious skin reactions
910
What does more protein in CSF mean?
Bacterial CNS infection
911
Sepsis 6 for child?
High flow oxygen, inotropic support, IV/IO access and bloods, IV/IO abx, involve senior clinicians
912
SEs of rifampicin?
Nausea, thrombocytopenia, liver problems and reduces efficacy of the pill
913
Management of septic child?
sepsis 6, fluid management (20ml per kilo), 3x bolus then intubate if not stable, metabolic disturbances found and corrected, catheterise
914
Give 2 DMARDs?
methotrexate/sulfasalzine
915
My HEART mnemonic for kawasaki S+Ss?
mucosal involvement like dry lips and strawberry tongue, Hands and feet with desquamation and oedema, Eyes non-purulent bilateral conjunctivitis, adenopathy of cervical lymph nodes, rash usually truncal and pleomorphic, temperature for at least 5 days
916
Treatment for kawasaki?
Aspirin and IVIg
917
Fluid management for DKA (values for shocked and not shocked)?
shock = 1st bolus 20ml/kg 0.9% NaCl, further use 10ml/kg; not shocked = 10ml/kg 0.9% over 1 hour
918
The MISFITS and NEOSECRETS causes acronyms for collapsed child?
o T: Trauma, tumor, thermal
o H: Heart disease, hypovolemia, hypoxia
o E: Endocrine (CAH, DM, thyroid)
o M: Metabolic disturbances (electrolyte imbalance)
o I: Inborn errors of metabolism
o S: Seizures or CNS abnormalities
o F: Formula dilution or over-concentration leading to hypo/hypernatremia
o I: Intestinal catastrophe (intussusception, volvulus, NEC)
o T: Toxins (including home remedies such as baking soda for burping)
o S: Sepsis
```
o N: iNborn errors of metabolism
o E: Electrolyte abnormalities
o O: Overdose
o S: Seizures
o E: Enteric emergencies
o C: Cardiac abnormalities
o R: Recipe (formula, additives)
o E: Endocrine crisis
o T: Trauma
o S: Sepsis
```
919
What medication to give for high risk of RSV (immunodeficient/CF)?
Prophylactic palivizumab every month
920
Longterm management for HF with septal defects?
ACEi, diuretics
921
Causes of faltering growth categories?
Intake decreased, increased metabolism/requirements, decreased absorption
922
Stool softeners examples for faecal impaction?
Movicol and lactulose
923
Stimulant laxative example?
Senna
924
What are TORCH and when are they referred to?
toxoplasmosis, rubella, cytomegalovirus, herpes simplex; antepartum infections
925
EEG for absence seizure?
3 spikes
926
First line treatment drugs for paeds epilepsy?
sodium valproate, ethosuximide
927
What type of seizure tends to happen in the morning and what type of epilepsy can it develop from?
Myoclonic from absence seizures
928
Cause of resp distress in premature baby?
Choanal atresia, IVH, sepsis, surfactant dysfunction, congenital heart defect, congenital pulmonary defect, pneumonia (strep B), sepsis (treat with benzylpenicillin, amoxicillin and gentamicin)
929
Treatment amount for sepsis in premature baby of benzylpenicillin?
25mg/kg
930
How does jaundice tend to progress?
From the eyes craniocaudally downwards
931
Obstructive jaundice signs?
pale stools and dark urine
932
S+Ss and aetiology of medium chain acyl CoA dehydrogenase deficiency (MCADD)?
fat breakdown; infections, fasting, diarrhoea, vomiting with encephalopathy with death if untreated
933
Treatment of MCADD?
IV/enteral glucose before BMs decrease
934
mnemonic PAMGU for main illnesses in kids?
pneumonia, acute otitis media, meningitis, gastroenteritis and uti
935
BINDS mnemonic for PMC?
Birth hx, immunisations, neonatal, development hx, shx
936
VITAMIN CDE for differentials?
vascular, infectious/inflammatory, traumatic/toxic, autoimmune, metabolic, iatrogenic/idiopathic, neoplastic, congenital, degenerative, endocrine
937
O SHIT for asthma management in severe attacks and IV treatment after this?
oxygen, salbutamol (nebulised and IV), hydrocortisone, ipratropium bromide, theophylline
IV = magnesium sulfate and then salbutamol
938
Give a tocolytic?
Atosiban
Phase 3a/3b
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