Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Ok, I can read the question. So an infant was born at 34 week gestation, have a low Edgar school. The mother has a past medical history of hypertension bipolar disease. Um and did some um and did not stop any of her medication during pregnancy. Which of the following fetal complication is the baby at risk of? Ok. So give you a few minutes to have a think and then if you could put your answers into the chart for us, it doesn't matter if you're unsure, just have a go the possible answer. We have uh nasal hyperplasia, Epstein, anomaly hydras, ectal defect and poor t they give me another 20 seconds. Sorry, I read the answer. Apologies. I used to. Oh, ok. You still here? Hello? Hello. You're still here. Yeah. Ok, good. Sorry. I don't know what happened there because it disappeared anyway. Um a couple weeks. So the answer is Epstein. And no. So we'll just talk a little bit about what that is. And so and also, yeah, so this is a rare congenital heart disorder. It occurs approximately one in every 200,000 live births. It's a malformation of the tricuspid valve and the right ventricle, which causes a bigger atrium and a smaller right ventricle. So we think about how the heart works. This would then cause poor flow from the right atrium to the right ventricle and poor flow to the pulmonary vessels. You will also get a right to left shunt across the atria and the atrial septal defect. We're thinking about when the baby's born and all of those ducts are closing. So how does it present? The baby will have evidence of heart failure? So, some of those symptoms that you'll be thinking about in adults will be the same. But in the neonate, you might hear a gallop rhythm. This is also a cyanotic congenital heart disorder. So baby will be blue, maybe have blue extremities, blue lips and shortness of breath. We diagnosed this with an echocardiogram. Uh Here if you just go back. Yeah, the question. OK. Why does this baby have this? So mother has a background of hypertension and bipolar disease. So with Epstein anomaly, it is actually associated with lithium, which is often given for bipolar disease. So that's probably what's happened to him. OK. Shall we go on to the next one? If anyone wants to ask any questions, they can put it in the cup, uh Will the slides be released? Yes, they're gonna be uploaded. We'll tell you more about that. Yes, the sides will be available and we'll try to put in some more information there as well. Ok. So I'll read the, the next question out for you. Ok. A four year old may present it to GP with fever and red tongue throat, sorry, in a red tongue. Um, and as well as a red throat, um, a course of pen V has so far been ineffective. She has had more than seven days of high fever, unable to bring in the fever. Pharmacologically. She'll see. She's also had cough and cries and on examination, she has widespread macular rash, right, hands and feet and peeling of the skin around the toes. So which of the following do you think is the cause um for this child's fever as well as the symptoms? Ok. So maybe take maybe a minute to think and then put you on the chart for us. I we give a few more seconds. We put some already good. So the answer to this is Kawasaki disease. Most people got this one right. Let's have a look at what is Kawasaki disease? This is a medium vessel vasculitis. It's common in Children aged between around two years old and older than five. It's quite rare. There's some pictures down here at the bottom. So we can see some of those symptoms that we were mentioning. So it's gonna be a persistent fever lasting more than five days dry, bilateral conjunctivitis. A non vesicular desquamating rash which starts at the extremities when you touch the child's skin, it feels like sandpaper that's one way to differentiate a strawberry tongue and the way that we will manage this is gonna be with aspirin and IV immune problems in the acute phase. We have to be careful with aspirin because it can cause something called Reyes syndrome. Uh And then long term, it's gonna be these Children need to be followed up with an echo because they can sometimes develop coronary artery aneurysms. So they will have always a follow up echo after discharge. Good. Ok. So we go to the next one. Yeah, that's very good. Yeah. So I think, um, when I actually saw someone with Kawasaki disease and I was doing my si and Pete's job, um, I actually saw a couple of patients in a week. So it is, even though it's, um, you know, I in the, it's generally in the population, it's not as common, but it is something that you would see, um, when you're actually working on pain or on your p place. Ok. Um, so yes, it is important to be aware and it's important differential to have in a kid who is having a fever that's persistent. There are also other differentials as well, but this is an important differential to keep in mind. Um, so it kind of, we will be covering, I think kind of related to this topic. I think we will be covering um the topic, a few topics on pediatric rashes. But if there are certain topics that we don't cover. Please do have a look because pediatric rashes are common to is a common topic that comes up in SBA questions. Ok, so have a look at what, what are the other kind of causes for pediatric rashes? Ok. A nine month old child presents to the emergency department with difficulty breathing whilst feeding. Last week, the child had some symptoms on examination. The respirate is 40 the heart rate is 100 and 60. There is sucking under his ribs, given the likely diagnosis. What is the common cause? Give it a few, maybe some time to think about it. Ok, everyone's gone for the same answer. I wanna see if you're correct. Er, yeah, it is RSV. So this is bronchiolitis. It's a common chest infection that primarily affects infants aged between one and 12 months and is caused by respiratory cinc virus symptoms is gonna be cough, labored, breathing, wheezing, tachypnea, intercostal recession, grunting and nasal flaring. But um, in the question we asked about the sucking in under the ribs. So that's subcostal recession. The management for this is gonna be supportive care, including oxygen and feeding assistance were necessary. In some cases, we might need to do the mechanical ventilation with CPAP. This is really, really common, especially this time of year. So right now when I'm at work, we, I see bronchiolitis at least once every day and sometimes the Children are quite unwell. They might need to have an NG tube to help with their feeding. Um We do have some babies on CPAP as well. So yeah, very common. Ok. Next question. Five year old boy walks with a limp due to right hip pain which is relieved by rest and worsened on walking or standing. The x-ray reveals a periarticular left hip swelling in soft tissue. Bone scan reveals reduced activity in the anterior and left a femoral pieces. So have a think about it, have a think read through the question. See what you think. Ok, the chart. So some people have an o maybe. Yes. So plus disease is correct. There's a lot of things that can cause joint problems in Children, but this one is perfect disease. So per disease is an avascular necrosis of the femoral head usually affects boys aged 5 to 10 years old, gradual onset of hip and or knee pain and limp may radiate to the groin or the back. I just wash with what might be similar to something that was called transient sinusitis. Now, this is when Children may have some kind of viral disease, um illness and then after with the viral illness, they get hip pain and that one, the Children annoyed me a little bit, a little bit um younger than this and it's gonna be a shorter history as well. So for this, you need to do hip X ray and frog leg lateral, which might show widening joint space, sclerosis, augmentation and eventually flattering or of the femoral head. They may also request for an MRI and to manage it. We just manage with simple analgesia and rest. If it's severe, then they might need surgery to secure the femoral head back into the acid tab. Ok, great. Here. Shall we move on to the next one? Thank you, Latino boy with, he has fallen while playing football. He has a swollen and bruised knee, which of the following is the best treatment in his case. Should I be answer? I need to do that. OK. Let's talk a little bit about the question. Hemilia B I, not a lot of people put answers in the chat. When maybe this is a bit of a harder um question. Let's go to the nation. Sorry. So, yes. Oh yeah. Can we go to the next slide? Thanks. Thank you. So, this is a factor nine deficiency and it's due to excellent mutations. So patients are only gonna be male because it's linked and they have Hema arthrosis that's leading into the joint hematoma in muscles, intracranial hemorrhages, they can bleed exclusively in response to minor trauma and can cause spontaneous hemorrhage without any trauma as well. The diagnosis is based on the bleeding score, coagulation screen and also genetic testing. We treat this with infusions of clotting factors. Uh Also desmopressin and transam acid. I don't know if you can see at the bottom this little uh inheritance in here because uh if you have with your female, you'll get two XS. So one of them is affected and the other one's not, then you'll be ok. Males only have one X. Yeah, there's a lot. Ok. Let's go to the next area. Thank you very much. Shall I read or read? Good boy. His body is, it's a Tyr. Ok. Oh, what did you say? Hea, uh, do you want me to read or are you happy to read? I don't mind. Ok. Uh five year old boys brought into his GP by a concerned mother otherwise fit and well, but for the past two weeks, he's been wetting his bed consistently every night. So what do you think that we should do? Got a few tests? Are we ready or do we need a little bit more time to think about it? Some people have said urinalysis will review fluid intake. What do we see? Ok. This one is about enuresis or athletic. So usually we would expect that Children would be dry at night by the age of five. And I had a look on the nice guidelines and they said that you can leave up to seven years old. In some cases. The general advice if a patient is coming with bed wetting, which called enuresis that we want to start with is looking at the fluid intake. Are they drinking a lot before bed? That would be the reason why they're wetting the bed. We should be encouraging regular fluid intake and try not to drink a lot at night, toileting patterns to encourage Children to go to empty their bladder regularly and before they go to bed, right. Other things that we can do in the first stage to manage, this is to give a reward system. So this can be something simple like a star chart. But we want to be make sure that we're giving the rewards, the stickers for good toileting behavior rather than for having dry nights. There's two types of enuresis. We've got primary nocturnal. So the child has never been dry at night. Uh most commonly due to a variation in normal development. Uh other things on the overactive bladder drinking too much uh failure to wake due to deep sleep. So for this, we want to start with the measures I already talked about. And the next after these is if that doesn't work, you can try an enuresis alarm which will wake up the child so that they can go to the toilet before they went to bed and then we have secondary. So, uh if people are talking about uti that is a very common cause of bed wetting. Another one is constipation or type one diabetes. So if these general measures have not worked, um or usually if the child was dry and then they started wetting the bed later on, it might be because of one of these causes. So we need to test for that it. I'd like to move on. Ok. Question 7, 10 month old girl presents to emergency department with abdominal pain and bloody stools. She draws her legs towards her abdomen and is refusing to feed her abdomen is soft and there's a sausage, thick mass in the right flank. What is the first line management for this condition? Ok. Good. Uh In it, this was intussusception. This is the condition that involves telescoping of the bowel in from a proximal segment into a distal one. I'll show you a picture afterwards. After we look at this slide, you the Yeah, there we go. You can see what's happened. It's gone in on itself and that's what's caused. That's the um pathology. It's quite good diagram. Um ultrasound pedia. Yeah, Children are normally, yeah, let's look at this next question. Now, one year old girl brought to the GP by her mother because she's shorter than most of her classmates. She's doing well academically on examination. She is short and has a webbed neck and widely spaced nipples. Ok. This is Turner syndrome well done if you got it right. And if you didn't get it right, that's OK. Let's talk about it. So this affects around one in 3000 girls. And the common symptoms are short stature, webbed neck, wide carrying angle, low set ears and primary amenorrhea. That's very common. Other features, underdeveloped ovaries and some cardiac anomalies such as aortic dissection or coarctation. The most common cardiac defect is a bicuspid aortic valve. They may also have recurrent otitis media, recurrent uti s and they treat this with uh estrogen and progesterone replacement. They all need fertility treatment when the time comes and growth hormones, therapy to help with the height. Yes. Ok. Next one, six year old with colicky abdominal pain, nausea, vomiting and diarrhea. Over the past three days, there is passage of blood in the diarrhea and mucus. They also have some joint pain, arthralgia, knees, elbows, ankles and wrists. There's a palpable purpuric rash on the extremities and there's microscopic hematuria and proteinuria plus one. Uh The last one is supposed to say dysentery. So these are your options. What do you think? Oh, really? Maybe a little bit. Really? Um Just going to ask, um, Leila, do you have the feedback? Hi, Sarah. Given you sent you the feedback. No, no, it's fine. I'll um, I'll just get it from her. Ok. I think we uh she already revealed the answer. Yeah, apologies. That's ok. What do, let's have a think. So, the other answers were hemolytic uremic syndrome, disseminated intravascular coagulopathy. And then he schoenlein purpura. So let's look at ITP. What is ITP? Sure. Uh Here, can you just click to the next slide? Thank you. This is an autoimmune condition that causes spontaneous low platelet count, which is why you get this. Also purpuric rash and it presents a bleeding bruising particular or purpuric rash you wanna investigate with FBC. And you might wanna also exclude some other things, especially in Children. You want to exclude leukemia. You treat them with steroids, IV, immunoglobulins, blood transfusion fusion and platelets if needed. They need to avoid contact sport. Uh and things like lumbar puncture as well because of their low platelets cause a lot of bleeding. Ok. Question 10, 6 month old boy has admitted to not being able to open his bowels since birth. He's not past meconium. His abdomen is distended and he's had several episodes of bowel, staying vomit and his uh X ray shows obstruction. What kind of investigation will be the definitive diagnosis? So it's not, what shall we do next? It's what's gonna give us the diag, we'll get a little bit more time. Nobody's written any potential answers. Remember, just give it a go. If you're unsure, it doesn't matter. We'll speak about it afterwards anyway. Ok. The investigation that's gonna give us the diagnosis is rectal biopsy. That's not to say that they may not do an ultrasound, but it's not gonna give us the diagnosis. So let's have a look. Why do we need to do this? This is Hirschprung's disease. It's a congenital condition where the nerve cells of the my plexus are absent in the distal bowel and rectum also known as alba plexus. So essentially the end part of your colon has no innovation. He doesn't relax, you're unable to pass stool because of this, which is why he has bowel obstruction and he cannot, he has not passed stool. So they're gonna have chronic constipation, abdominal pain distention and they may have full weight gain and failure to drive. So we did the X ray that was already in the question, which showed some obstruction, but you must do a rectal biopsy to confirm this absence of ganglionic cells on the histology. And we managed this by removing that part of the bowel that's not innovated. And in the meantime, if child, child is hypertensive or septic, you're gonna give fluids and antibiotics as appropriate. I have that cleared up any confusion. An infant born to a mother with poor nutritional status was born with a midline lesion and cystic mass around the spinal canal. What do we think may have caused this? Yes, folic acid is the answer to this one the next and I'll show you what it looks like. So can you see down here at the bottom of the baby? It shows you the defect, this is spina bifida. This is uh quite rare this day and age because folic acid. Uh this is common knowledge. We always advise pregnant women to take folic acid for this reason. So normally in the first month of pregnancy, a special set of cells will form the neural tube but it doesn't close spot properly in spina bifida due to the folic acid deficiency and there's lots of food that is rich in it with dark green vegetables, egg yolk and fruits and it is managed by surgery. Next question, question 12, a two year old girl was running around the playroom and bumped her head against the table following which she fasted became pale and lost consciousness. She had some limb Jacky movements but quickly regained consciousness. What is the cause of this episode? Yeah. Uh options are meningitis, epilepsy, hypoglycemia, reflex anoxic seizure or febrile convulsion. Hey, somebody did say the right answer with a reflex anoxic seizure. It occurs when the child is starting. They will suddenly go pale, lose consciousness and it's a very quick seizure. The other, well, meningitis can cause seizure but I think the other options, the seizure will be longer. Oh, hurry up. Oh, sorry. Did the, did the slides just go? Yeah, sorry. I'll just um I'll just share again. I'm just trying to get the feedback from at all. Um OK. One first bear with me. I will be with you in a moment to try to get the link you are you see? All right. Um Sure I was just going to ask you, did you say you had the, you have the access to the link? No, I don't have the CPAP. There are a few more questions though. Yeah, I know. But it's just, I'm trying to get the feedback because um you know, they will, we can't have, it's really low. Mm It's something. Yeah. Apologies guys. It's just um I'm just trying to just wanna make sure that you guys have the um the feedback form. So please don't go without filling the feedback. We would really appreciate it of how we can improve for next time. Um So this teacher has put in quite a lot of um I'm gonna reha the slides now. Uh OK. Management of this is gonna be educating and reassuring parents and I deficiency anemia. OK? That's fine. I can dance. So hopefully everyone can see the feedback from now. Let's go to the next question. I'm hoping it's helpful for you guys. This one is a baby born at term has no respiratory effort. At one minute. The baby is tachycardic and looks blue and the baby is not making any movements and there's no femoral pulse palpable. What is the next thing that we should do to resuscitate with spain? OK. Should we get to the answer? People have said that it is five breath. It's actually to dry the baby. I just added this in because in neonatal life support, the first thing we want to do is dry the baby and keep them warm because that if the baby is cold and we've warmed them up, that might cause them to start breathing again. After doing this. You're right, we will be doing the five breaths. So that is you are partially correct. So I just wanted to draw your attention to this and I've got the algorithm here. So when you get the slides, you can look at it in your own time. Yeah. Show me one. I don't think there's that many questions left. 14 year old toddler brought in by his mother to the emergency department with barking cough fever, stridor, low oxygen saturations and intercostal recession. It's tachycardic with a, an tachypneic and diagnosed with croup. How should we treat this child? Yeah. Good. I think most of you have put um OK. Some of you have said ae the mimosa that's from the last question maybe. Oh, so nobody has said anything for this one, have they? No as in, I think the five breasts are number one was about the previous question. OK. Fine. OK. Sure. Yeah. So a single dose of Dex and admit in the pes it. OK. F so I'm just reading the answers. So the diagnosis here was actually croup have uh could you just let us know in the chart if any of you have seen proof whilst on placement or I just uh or if you're working, you come across group, you guys still with us, right? Can you still hear? Yeah. Could you please just let us know in the chart if you can hear us and if you're still with us? Oh, has oh, there we go. Perfect. Yeah, that's fine. I mean if you, if you don't want to answer, you know, if you don't want to message directly, please do me message the teacher privately like if you don't want to tell the answer to the co group, but please do engage. Ok, we've only got a couple more left, I think. Um and we can leave the, I think how is this question number? We'll carry on with those two questions now. Yeah, if you've only got a couple left, so please try and engage with us. Ok. Not long left. Um ok, I'll let you explain later. This is uh cr uh it's upper respiratory tract infection that causes some edema and it's from parainfluenza virus. And normally the hallmark of this is the barking cough that's gonna give it away. There. Also fever, maybe Stridor or horse voice. We treat this with dexamethasone to bring down that edema. We also give some supportive treatment as needed fluids, rest oxygen. And if it's severe, you may give nebulized budesonide or nebulized adrenaline. So, nebulized adrenaline when you have a patient with Stridor, this is in patient. Um, Children and adults nebulized adrenaline helps to open it up again and get rid of that Stridor. And if it's very severe, you want to intubate the patient and start ventilation. But yeah, crip is very common. Actually, I've seen it quite a lot at work. Smear glum. Ok. Your GP with six week history of knee pain. So this is another one about uh joint pain in Children. There's a quite a different few things that can cause this. So that's why I want to add a few questions. She's got tenderness on her tibial tuberosities and she does athletics, my ligament stress tests are normal. So, what kind of management is it? And then a bonus question. If you have any idea of the diagnosis, you can put that as well in the chart. Ok. Nobody wrote anything in the chart. 01 person was written. Yeah, it is analgesia physiotherapy and reduction in exercise. Anyone have any idea what is the condition you can put it in the chart. If you don't, then that's OK. Yeah. Have a guess. If you know what the condition is, there's no right or wrong. I mean, obviously there are right answers, but it's OK if you don't if you give it a guess because it's all about learning, isn't it? Um Yeah. OK. It's always good. Yeah, this is uh inflammation at the tubule tuberosity where the patella ligament insert and it's quite common in adolescents. So they may have a uh um fatigue and pain is exacerbated by physical activity kneeling or an extension of the knee. So usually this is like Children, um Children who are quite active, maybe they're playing sports and you manage this, this conservatively reduce the physical activity, nsaids and ice. Remember your rice rest ice compression elevation. That OK. Next one. Yeah, I'm here. This is the last question. Actually, a baby is born at 10 and starts to have nonbilious vomiting at two weeks and they have a small olive mass in epigastrium on examination. So guys don't forget to uh put your your thoughts in the chart. Oh, look, Nabby has written a nice exclamation in the chart. Can everyone see hyper? So it is pyloric stenosis hypertrophy of the pyloric muscle so that they will get nonbilious projectile vomiting. Oh, very nice. Let's have a little look at. So the next call good, we examined the baby after feeding. Often the peristalsis can be seen by observing the alcohol abdomen and it feels like a large olive because of the muscle. Very good. So we will diagnose this with an abdominal ultrasound and you can see the thickened pylori and they will need surgery, something called laparoscopic pyomyoma, myotomy. I really hope this has been helpful guys. Has it been helpful you on the last line? Uh I think we'll just show the things we have covered. Uh It has been helpful that yeah, so the last slide we just show the topics that we've done. Um Yeah. Thank you for coming. I really hope you enjoyed and I hope it was helpful if you learned something. Yeah, perfect. Thank you so much, everyone. I really appreciate it and thank you so much for your time to teach. Thank you. Thank you. Thank you. Please. Um give me the feedback for Leila. If that's ok. Before you go, it's a very short feedback form. Um Just let us know um what she has done, you know, what you like about the teaching and what else would you like us to kind of improve? Not just about Leila's teaching specifically, but just generally about a, you know, um and we also have a youtube channel guys that we have um it's all about application process and, you know, um and we also do kind of, we have guests where we do podcasts as well. Um And we do tips on studying and lectures and things. So do check out our youtube channel, subscribe and, you know, let us know, you know, what else you would like us to kind of do as well. If there's anything that we're missing at a that you'd like to see us do in the future, please put it in the feedback form or let us know. Um OK. Um Yeah, but other than that, um you know, uh uh you know, we have uh if I go back to the poster, actually, sorry. Is that OK? We've got people, sorry guys, we've actually finished now. Um Apologies for that. I mean, it's, it was a quick session but she just, oh, I'm just gonna go back to the beginning. OK. So this is the poster. Um So we've got Pete today, we've got 12345 more sessions to go before the end of the year. Oh, sorry. Before the end of this uh series, all the previous lectures have are on meal. OK. So if you guys aci medical series med all go to Medal. We have all the lectures from previous um specialties uploaded and um obviously they're all quite obviously delivered by junior doctors and medical experience, junior doctors and medical students. Ok. Um So do check out check out Medal for all the previous lectures from the year. So we have also got other um sort of resources from previous as well and there's those of a stuff there as well. So, you know, check out the med account for more resources and for more content. Um But yeah, thank you so much and take a picture if you want to or, you know, have a look at our website. Um But otherwise if you have any questions, you can mess, you know, put it in the chat now or you can message us on Facebook. I and I'll try and answer them. Ok. Um Otherwise, uh thank you everyone for joining us today. I would actually stop recording. Let me just stop recording first. Sorry.