Paediatrics

double bubble sign

non-blanching

Holliday-Segar Formula

caused by S. Pneumonia, H, Influenzae or M. Catarrhaxis
results in pain in the middle ear and an inflamed tympanic membrane
complications: mastoiditis, facial nerve palsy, hearing loss, meningitis, encephalitis, tympanic membrane perforation, glue ear
management: analegesia, hydration, antibiotics - Amoxicillin if bilateralecurrent/age <6 monthslue ear

investigations - C3 levels, ASOT, FBC, CRP/ESR, U&E, urinalysis
management - fluid and salt restriction, diuretics if oedema, antibiotics if infection persists, BP, U&E monitoring, urine output monitoring

place patient in recovery position, remove objects from mouth, give high flow oxygen and buccal midazolamectal diazepam

presents with arthraliga, fever and a salmon-pink rash
FBC, CRP/ESR, ANA, RF, US
treatment focuses on NSAIDs, corticosteroids, physiotherapy and DMARDs e.g. methotraxate and azothiaprine, biological therapy too

exclude life-threatening conditions;
sepsis, meningitis, encephalitis, UTI (very common), viral infection e.g. bronchiolitis
admit and do a septic screen; FBC, CRP/ESR, glucose, CT then LP, blood culture. U&E, CXR

caused by viral illness e.g. enterovirus, cocksakie (most common), parovirus B19
ECG, echo and troponin
management: analgesia; paracetamol/NSAIDs

this refers to abdominal pain with no change in urinary or bowel habits and no fever following a viral infection, it is self-limiting

at 1 and 5 minutes after birth

ITP, aplastic anemia, bone marrow failure e.g. due to medications e.g. chemotherapy, or illnesses e.g. CMV, parvovirus 19

occurs when aspirin is given to <16 year olds; except in Kawasaki disease (required)

ALL

vesicular rash

posterior ears, short jaw rocker bottom feet and overlapping digits

valsava manouvre, adenosine, DC cardioversion

WPW; delta waves

absence of P waves, narrow QRS complexes, tachycardia >160bpm

microcytic anemia

reduce cow milk intake, take vit C, ideally with oral iron supplementation to increase absorption, increase red meat, spinach and broccoli intake

Aspirin and IVIg

tetralogy of fallot
transposition of great arteries
TAPVR
tricuspid atresia
truncus arteriosus

respiratory failure
autonomic dsyfunction - HR and BP

bone marrow aspiration + biopsy - >20% blasts
flow cytometry; b/t cell type

S. Pneumonia, M. Catarrhaxis and H. Influenzae

hearing loss, mastoiditis, brain abscess, facial nerve palsy, tympanic membrane perforation

asymmetrical epicanthic folds, upward slanting eyes, simian creases, protruding tongue, flat facial profile, small ears, hypotonia, sand gap deformity; large space between first and second toes, short neck

Hb electrophoresis

bone marrow aspirationiopsy
immunotyping

ALL more common in children
ALL - lymhoblasts
AML - auer rods

pathological - <24 hrs
physiological - >24 hrs

deficinecy in surfactant leading to ground glass appearance on x-ray, tachynponea, nasal flaring and cyanosis

sunsetting eyes

true

False; physiological vs pathological

true

True

using dipsticks

hyperlipidemia, proteinuria, oedema, hyperalbuminuria

True

IV furosemide and dialysis if no response

in Fanconin anemia (bone marrow atrophy) and NF1

Turner's syndrome, trisomy 21

genetic testing - CTFR gene
sweat chloride test

congeintal heart defects; AVSD
hypothyroidism
duodenal atresia/Hirschprung disease
asymmetric epicanthic folds and upward slanting eyes
protruding tongue, round face
coeliac disease
brushfield spots
simian fold
alzheimer's disease
mental retardation
lung disease

thyroid tests and coeliac testing

meiotic non-disjuntion

deletion of chromosome 18
EDWARD
cleft palate, digit overlap on flexion, wide head, rocker bottom feet, diseased heart

45 X
hypergonadotropic hypogonadism (high GnRH, FH, LH and low oestrogen)
ovarian agenesis; amenorrhea
webbed neck
wide nipples
infertility
congenital heart defects; coarctation of the aorta
short stature

in males; 47 XXY

tall stature
reduced facial/pubic hair
micropenis and testicular atrophy
gynecomastia - increased risk of breast and testicular cancer
reduced fertility

hypergonadotropic hpypogonadism; high FH and LH, high oestrogen and low testosterone

aortic dissection/aneurysm - ACE-I to reduce high BP
tall stature
joint hyperflexibility
subluxation of lens - slit-lens

CATCH22

deletion of chromosome 22
thymus atrophy - immunodeficiency
mitral valve prolapse
long head and large ears
ASD

due to damage to the common peroneal nerve leading to symmetrical atrophy of anterior and lateral muscles of the leg, pes cavus, absent ankle reflexes, claw toes, foot drop and high stepping gait

proximal muscle weakness; Duchenne muscle dystrophy

tachycardia >180 bpm
absent P waves
sudden onset

CK (elevated)

UMNL

hypochloremic metabolic alkalosis

US - hotdog sign

refers to inflammation of the synovial memebrane of bones, associated with URTI, ddx of septic arthritis - excluded by blood culture and synovial fluid aspiration

night pain
systemic symptoms e.g. fever etc. - malignancy
bladderowel incontinence - spinal cord compression

refers to lateral rotation of the spine and rotation of the vertebrae
Cobb's angle >10 degrees, limb lengths and x-ray

more common in females, the left leg is more affected
Ortolani, Barlow and Galeazzi tests are all positive, asymmetrcal gluteal folds and leg length discrepancy

more common in males, results in the malignancy of the metaphysis of long bones
starburst sign on x-ray

tumour in the bone marrow, more common in males

occurs due to S. Pyogenes leading to sand-paper like rash on the body excluding the palms and soles, lymphadenopathy, strawberry tongue and fever
Mx: co-amoxiclav

cannot be treated; only prevented by vaccination
syptoms: lymphadenopathy followed by a maculopapular rash

B19 virus - lace-like rash on face

Koplik spots

head and extensor areas, excluding diaper area

blanching - less severe, indicates increased blood flow e.g. measles, Rubella, Impetigo, Scarlet fever, 5th disease, contact dermatitis, atopic dermatitis, urticaria
non-blanching - more severe, blood leakage e.g. vasculitis e.g. Kawaski disease, meningitis, septicemia, coagulopathies e.g. DIC, leukemia, erythema nodosum

more common in obese boys, presents with an externally rotated hip, hip and knee pain

signet ring sign (tram track)

sweat test (alone not diagnostic), genetic testing for the recessive CTFR gene, LFTs - steatorrhea, faecal elastase, glucose tolerance test, spirometry - lfts, sputum culture, HRCT, CXR - hyperinflation of the chest

oxygen, salbutamol, ipratroprium and corticosteroids - acute exacerbation
salbutamol, LABA (tremor, hypokalemia) and corticosteroids for long-term, consider using a spacer to reduce risk of candida infection with corticosteroids (candidiasis)

refers to infection of the bronchioles in infants <2 years. Due to infection by RSV, this leads to copious amounts of sputum and respiratory distress + fever
treatment with high flow oxygen - CPAP and clearing of secretions. vaccination available
ddx: pneumonia, cystic fibrosis, asthma attack, bronchitis

ddx. epiglottitis - more severe, no voice, drooling and develops in hours due to Haemophilius influenzae type B - risk of choking (mx - antibiotics)
Parainfluenza virus
oxygen and dexamethasone
characterised by fever and a barking cough

mycoplasma pneumonia

empyema

periorbital oedema, tongue swelling, urticaria, bronchospasm and wheezing
Mx: IM adrenaline, IV leads to VFib so avoided
due to food e.g. eggs, seafood and peanuts, pets etc.

yes - against RSV

RSV

painless lymphadenopathy, B symptoms (fever, weight loss, night sweats), no extra-nodal involvement
Reed-Sternbnerg cells on biopsy, CD15 and 30 on immunohistochemistry
BVCD therapy

painelss, hard lymphadenopathy with extra-nodal involvement e.g GI - worse prognosis
no Reed-Sternberg cells and CD3 - T cells and CD20 for B-cells
C-RHOP therapy

lymphadenopathy, hepatosplenomegaly, fever, malaise, bleeding, brusing, infections
FBC; low platelets, high/low WBCs, low Hb
bone marrow aspiration - lymphoblasts
immunohistochemistry - TdT positive

CAR-T/chemotherapy

Wilm's tumour - nephroblastoma - abdominal mass, pain, haematuria
Retinoblastoma - visual disturabnces, loss of red reflex - autosomal dominant
Li-Fraumeni syndrome
Neurofibromatis type I - pheochromocytoma

brain/spine - raised ICP - visual disturbances, headache, vomiting, cranial nerve damage - seizures etc.
Hodgkin's lymphoma - EBV/non-Hodgkins
ALL (before the age of 5)
retinoblastoma
Wilm's tumour

secondary malignancy, infertility (chemotherapy espeically alkaloids), psychological effects, osteoporosis, stunted growth, cardiovascular disease e.g. heart failure

this refers to the low neutrophils <500 and the presence of fever 5-10 days after a round of chemotherapy due to myelosuppression

broad spectrum antibiotics - Piperacillin-Tazobactam, antifungals if the fever doesnt resolve after 5 days, and G-CSF also as prophylaxis; avoid IM injections, good oral hygiene and candida prophylaxis and good nutrition
Ix - bloodrine culture, FBC, CRP/ESR, glucose, LFTs, U&E

24 hrs - ondansetron (5-H2TAA), dextamethasone
18-24 hrs - dexamethasone
anxiety - CBT and anoxiolytics - benzodiazapines

false - patient should be started on ondansetron before the patient starts to feel nauseous
s/e: dizziness, fatigue, headache

pulomonary fibrosis - Bleomycin
cardiotoxicity - doxorubicin
hair loss (alopecia)
permanent infertility - alkylating agents mainly
constipation - medicatoins e.g. chemotherapy, opioids, anxiety, dehydration
diarrhoea - give Loperamide and ensure replacement of electrolytes
renal toxicity - cisplatin and cyclophosphamide
peripheral neuropathy - vincalkaloids

type I

type I diabetes - polyuria, polydypsia and weight loss; destruction of beta cells
type II diabtes - obesity leading to insulin resistance
gestational diabetes
cushing's disease
corticosteroids use
cystic fibrosis

diabetic ketoacidosis; pear drop smell, vomiting, kussmaul breathing, abdominal pain, drowsiness

trisomy 21; asymmetrical eye folds and upturned eyelids, hirshprung's disease, duodenal atresia, cardiac problems - VSDs
cystic fibrosis
congenital rubella syndrome
early introduction of cow's milk

anti-islet, anti-insulin antibodies

HbA1c, fasting glucose, random glucose

no

yes since vomiting/diarrhoea can predispose to hypogylcemia while hyperglycemia can also occur

A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. CFRD
D. MODY
E. Secondary diabetes

VSD

by Echo

VSD

no cyanosis
ASD, VSD (leads to heart failure), PDA, AVSD (heart failure, associated with Down's syndrome),

prostaglandins

tetralogy of fallot
transposition of great arteries
coarctation of aorta

PDA

boot shaped heart
cyanosis leads to squatting to relieve symptoms

the pressure is higher in the arms than in the legs
absent femoral pulses

rib notching

Lithium use resulting in tricuspid regurgitation and stenosis

left to right shunting

obstructive lesions

this results when there is a left to right shunt causing cyanosis due to blood flow reversing resulting in hypoxia and increased pulmonary hypertension.

down's syndrome, angelman and pateu syndrome, congenital rubella syndrome, foetal alcohol syndrome, warfarin, lithium,

48 hours after birth

True

above the 98th percentile

true (pre-mature infants have a higher risk due to depleted and not fully formed stores)

yes

malabsorption (coeliac, IBD, lactose intolerance), chronic illnesses/infetion, vomiting, poor feeding e.g. premature

at 4/5 months

fragile X

unbiased, blinded and RCT

inconsistent history and injuries, delay in presentation, change in history

stereotypical behaviours; head banging and rocking, outbursts e.g. shouting, rigid routines and lack of creativity and imagination
2-4 years of age

sleep disorders, hearing/visual impairements, conduct disorders, learning disabilities

associated with congenital heart defects - AVSD, VSD
hirschprung disease
type I diabetes
hypothyroidism
asymmetrical ecanthic folds and upward slanting eyes
developmental delay

via an anomaly scan - thickened nuchal fold

herd immunity - giving protection to people unable to take vaccine (vulnerable e.g. immunocompromised people)
prevention of illness
eradication of diseases e.g. small pox
community protection
prevention of certain cancers e.g HPV for cervical and hep B for liver carcinoma

live attenuated vaccines - MMR
inactivated vaccines - killed virus e.g. hep A
contain part of the virus e.g. HPV
mRNA - contain messenger RNA e.g. COVID-19 vaccine

fever, sore injection site, rash
severe: anaphylactic reaction; give adrnealine, febrile seizures (children) and GBS (rare)

immunocompromised, egg allergy NOT a ctd, anaphylaxis, current illness, recent blood transfusion

6 in 1 (Hep B, dyphteria) at 2,3,4,18 months
3 in 1 (MMR) at 8 weeks, 4-6 years and 13 months
PCV at 8 weeks and 12 months
HPV at 12 years and 12.6 years

viral - lymphocytes
bacterial - neutrophils

bacterial - neutrophils, high protein, low glucose, high pressure, cloudy CSF
viral - lymphocytes, normal protein, normal glucose, high pressure, clear CSF

varicocoele

N. meningitis

hydrocoele

malignancy; seminoma

this rfers to abnormal formation of the urethral opening; ventral or underside of penis

primary amenorrhea

varicocoele

CRASH and BURN (less than 5 years of age)

complete heart block in the child