Computer generated transcript

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

Ok, great. So I think enough people have, have joined now so we can start and more people can join later, just going to show my screen. Ok. Hopefully you can also see my screen if you cannot, uh let me know someone can unmute themselves and let me know. So, hello everyone. Uh This is part of the IC Symp 05 cross score series. And uh today's session is going to be on miscellaneous conditions. We, so we're going to go through um virus conditions from uh multiple uh pediatrics are specialties and my name is Angelos. I'm a final imperial and hopefully, uh you find this session helpful. Ok. So what we're going to go through today is uh we're going to go through uh go over a non external injury and then some uh neurology, hematology and oncology, uh conditions. I selected some really high yield conditions that might um um see in your exams and your pace surgery and exams. So hopefully this will be um a session, high yield where you uh learn important stuff. This is a mental code at the bottom uh that I'm going to, at the end you're going to have some SBA S so you can log in from now or you can, you can regulate whatever is better for you. Ok. So let's start first with uh non accidental injury. So Children do not present in various ways. Uh They might have some bruising burns, fractures, um head trauma or some uh ocular manifestations in their eyes. And there's a specific um type of a non accidental injury called second baby syndrome, which you might have heard of. And there's a characteristic triad which consists of subdural hematomas, retinal hemorrhages and encephalopathy. So, um these Children uh present with uh these three characteristic um mm S uh symptoms, investigations wise, um physical exam and history are the most important uh for this uh uh for this presentation, this is where you get more, more than more the most of your information as you understand that this is um something that might be going on uh like a non accidental injury investigations wise. Also, bloods are important. For example, if uh the patient might have some bruising um clotting screen to rule out any um clotting disorders would be important fundoscopy. As you can see, as we all mentioned that there are ocular manifestations such as retinal hemorrhoids. And then if there's any head trauma, I see the head will be really important as well. And the skeletal ce is a series of um x rays of um of the bones in the body to see if there is any uh any fractures management wise, it's really important to um involves safeguarding Children, safeguarding and social workers and um in severe cases um until they might require neurosurgical intervention. But this is uh the management for this uh for non accidental injuries, really a case to case moving on now to uh febrile seizures which are really common uh in young Children and you, you probably encounter them uh in your presentation um if you haven't already uh have. So, so the, the definition of febrile seizure is a seizure in a child with fever, age between six months and five years old. This is the most um common age ranges that um to have febrile seizures. Outside of these ranges. This should be an investigation of um of other causes for seizures. It's commonly uh common, common causes are resulting in which is uh commonly due to A B6 and influenza infections presentation wise. They, they're usually quite short, less than 15 minutes duration, even even less. Uh usually, and they usually tonic clonic and afterwards, the child quickly recovers to the pre um pre seizure state, the baseline, it's often a clinical diagnosis. So you based on the history and some um symptom infection symptoms that the child might have prior uh to the to the seizure. However, however, it's important to identify the infection infection source uh in order to um avoid any uh any problems or any severe uh diagnosis may have been missed for management if the seizure lasts more than five minutes, a benzodiazepines uh could be given in order to stop the seizure. Antipyretics can be given to help with the fever. However, it's important to um let the parents know that they do not prevent febrile seizures and they do not prevent the recurrence as well. And a hospital assessment by a pediatrician should be arranged if the child has a complex seizure, if it's uh the child has is less than six months old. If there's any focal neurological deficit after the seizure, if you, if you don't know the infection origin, and if there's a suspicion of meningitis and encephalitis, it's an important diagnosis that of course, it shouldn't be missed moving on to cerebral palsy. This is a condition. It's a group of neuro nonprogressive uh motor disorders which uh can be due to prenatal, prenatal or neonatal insults due to um during the, during these periods. And often um a cause is not identified. However, there are certain risk factors that are associated with it. For example, prematurity, low birth weight, metal infection, multiple births and trauma are some of the uh main uh risk factors. There are several types of cerebral palsy. Um If you can, if you inserts uh spastic uh toxic uh kinetic, there are a lot of them um which I think it's more for later stages uh knowledge for later stage. However, you need to be aware of uh the vague presentation how this child, these Children present, we often have um delays in gross motor or fine motor developmental milestones. A a buzz phrase um that you might see in your SBA is that they have a hand preference before their first year of aids. So keep that in mind, they might then depending on the type, they might have spas, spasticity, ata ataxia, or they might exhibit a characteristic toe walking and space and cognitive disabilities are also common. It's again, clinical diagnosis, history and um examinations, developmental examination, neurological examinations are the most important uh for diagnosing cerebral palsy. However, um the brain imaging can be useful in some instances such as uh MRI in order to um could analyze the uh any lesions that you might see and white or gray mother injuries can be are often seen if anything is seen. The brain imaging. Unfortunately, there is no cure for cerebral palsy. So this is something that the that the patients will live with uh during their lives. And this is a characteristic condition that definitely needs an MD approach. So if you have it in your cases, I definitely mention that occupational therapist, physio, physiotherapist, uh speech therapist might be involved uh neurologists, pediatricians, and there are some medications that can help with symptoms such as diazePAM and D swelling. Uh However, as mentioned, there is no cure. Unfortunately, moving on to hematology now. So sickle cell, sickle cell disease, I'm sure that all of you have heard this the and with sickle cell anemia being the most severe form of sickle cell disease. This is an autosomal recessive signal gene defect in the beta hemoglobin chain which causes um the production leads to production of hemoglobin. And the, the um here on the right and top right, we can see the different types of uh red blood cells. So the normal blood cell here is this one the classic ape. However, the sacral cells have these characteristics, ape, sickle cell trait, which is when you only have one of the two with recessive genes. And for uh sickle cells, sickle cell disease offers protective defense against malaria. Thus, there's a higher incidence in endemic regions such as sub Saharan Africa, common uh signs and symptoms of um sickle cell include uh parallel uh due to anemia, jaundice and failure to five and often first presentations uh will be at the characteristic vasoocclusive process. So, due to the shape, as we can see here on the top, right, name, often sickle cell, um red blood cells cause uh occlusion in the vascular or, and this leads to these crisis. Examples include dactylitis where the fingers of the tongue get swollen and acute test syndrome where um they present with this and, and uh fever. Another um complication of the sickle cell will be a splenic sequestration, which is when again, there are blood cells get drop in the um in the spleen and that's um, um, that's causing a splenic cation investigations for a sickle cell. Of course, uh, blood and blood count, iron studies are really important. Uh, that through that you can exclude other anemia causes as well. And, um, hemoglobin will be, will be low, probably peripheral blood smear in the, in the peripheral blood smear. You'll see sickle, sickle red blood cells or, um, how it's all your bodies. And, um, hemoglobin electrophoresis is a really useful investigation to differentiate and to find out whether actually um the child has a hemoglobin s or and what proportion of hemoglobin, normal hemoglobin, hemoglobin ss. The management of sickle cell uh disease includes long term management and then managing the acute crisis. So for long term management, folic acid is really important as and is used for a lot of Children as it is believed that due to the uh hemo anemia that um the patients have folic store, the erythropoesis is, is stimulated and that's the folic stores are depleted. That's folic acid can be used too um to alleviate that prophylactic antibiotics, especially for Children with splenic sequestration as the spleen is not functioning that well. And they are more at risk for infection infections, especially with encapsulated organisms. And hydroxyurea increases the proportion of hemoglobin f beta hemoglobin, which cannot be um uh with red blood cells. Um the hemoglobin f cannot turn into sickle red blood cells and that is leading to less crisis, acute managing those crises is important, of course. Um And options include supportive care, obviously, analgesia as needed, antibiotics when there's a sense of infection and in severe cases, blood transfusion as well could be indicated. Of course, if you have any questions while we go through the uh the slides, let me know. Otherwise you can ask me at the end. Move on now to hemolytic uremic syndrome. This is a classic condition that is mostly seen in uh in peds. And there's the uh characteristic triad of micro microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. It's mostly seen in Children less than five years old. It can be seen in all the patients as well. But this is the main uh demographic and um it's usually caused by a specific subtype uh of E coli which causes, which produces um ziga toxin. This type of piccola is often transmitted through undercooked meat. And the patient might present to um to hospital with our to the primary practice, primary care with blood di and abdominal pain. And when you start doing investigations and doing some bloods, you'll see that of course, you will be anemic. The c will be anemic. They have low platelet levels and and have high creatinine due to the uh kidney, acute kidney injury. And because the anemia is a hemolytic anemia type, they also have a high likely dehydrogenase and decreased hemoglobin hemoglobin uh binds to the free hemoglobin in the blood. So, since there's hemolytic anemia there's a lot of free hemoglobin. Uh he togb binds to it. So there is uh less um levels and reduced levels available in the patient of blood smear. You see histocyte due to uh red blood cells being um injured, uh due to damage. Uh Pelli and stool culture or PCR can be used to detect the ziga toxin management is mainly uh supportive chair. So, hydration, fluids and uh observation and monitoring uh monitoring the patient that they don't deteriorate. And in severe cases when they have severe AKI dialysis might be indicated as well. Moving on now to uh the oncology and acute lymphoblastic leukemia. So, acute lymphoblastic leukemia is uh the leukemia most commonly encountered in Children and it's uh malignant proliferation of lymphoid presenters, mostly cases as well of uh as well the occurring in Children less than six years old. So, in younger Children like sim, similarly to the other conditions that we have gone through already and all Children might have uh pa and fig the anemia or bleeding due to uh thrombocytopenia. The low number of platelets and fever due to um low number of uh neutrophils. So this is um the symptoms, the low number of platelets, neutrophils and the anemia, low hemoglobin is because the uh lymphoblasts infiltrate the bone marrow. So le less amount of these cells can be produced, the bone marrow cannot function properly. The lymphoblasts also sometimes infiltrate uh lymph nodes and the liver of the spleen that's causing lymphadenopathy or hepatosplenomegaly. And um, common complication is, uh, cns involvement. So, um, be aware of that as well. If you see any child with, um, the human and your replacements for investigations, again, blood count is really important. We'll see exactly the, this part that you mentioned with anemia, neutropenia, thrombocytopenia, and leukocytosis in the peripheral blood smear. You can see an increased number of lymph lymphoblasts. And here on the top right, we have uh an embo comparing a normal blood with a um a normal blood smear. It's a blood smear of a child with acute lymphoblastic leukemia. We can see they have much more uh lymphoblast a lymphoblast presence in the smear bone marrow biopsy which might be uh performed will show the infiltration of the leukemic lympho blast that we mentioned and set genetic homological testing, um, might be indicated as well as there are certain um, chromosome test medications that are normally associated with uh lymphoblastic acute lymphoblastic leukemia management. I think it's important at this stage to know that uh chemotherapy is used uh various medications, um uh that are included in uh the treatment, uh chemotherapy, uh medications. So there are induction, uh therapies, maintenance and consolidation therapies. But I don't think you'll be asked exactly what kind of uh, medication can have medication that the child needs to have. So, moving on now to wounds tumor. So, wounds tumor or otherwise known as nephroblastoma is the most common renal malignancy during childhood. Again, it's usually seen in jungle Children less than five years old. And how the surgeon will present is that to have a unilateral painless abdominal mass. Um sometimes they might present with pain uh and in the abdomen, but it's usually a painless mass hematuria or hypertension might be seen in some Children. Well, not in uh not, you know, like the um painless abdominal mass and often some Children may have systemic symptoms as well. So, uh fatigue, um or uh fever and night sweats investigations, uh bloods uh were and testing for the renal function is important to me to see how the uh the kidney, the kidney w kidneys work. And they have, they been affected by the tumor. Usually the an ultrasound of the abdomen with Doppler will be done first to in when there's a suspicion that uh there is a, a lung tumor and then a CT or MRI of the abdominal pelvis will be performed to have a more detailed look at the tumor if there's any suspicion from the ultrasound and to clearly visualize it, visualize it. Nephrectomy is often performed to um to remove the tumor causing the whole of the kidney. And sometimes uh chemotherapy or radiotherapy uh can be used depending on the case and, and all this will be months with senior input. Of course. Now moving on to the final parts of the um uh part of the uh of the presentation before we go to the questions. So we have now two common uh bone cancers that are usually seen in Children. And these are osteosarcoma and Ewing sarcoma. So we'll go through them, go through them uh side by side. And we compare each part of the uh So c epidemiology in order to differentiate them easily, osteosarcomas, uh the origin is from osteoblasts, whereas the Ewing sarcoma is from uh neurectoderm. This is all from embryology. If you remember epidemiologically wise, both of them are usually seen in uh in Children in adolescents. So in the second decade of life, gene sarcoma is uh commonly uh present in white males, white male patients in that uh in this age age range location of sarcoma is usually in the metastasis of a long bone, usually uh in the knee and the urine. The location of the urine sarcoma is often in dialysis of the long bone, often uh in the femur and here and the emer at the top, we have um you can see where they are in me and diaphysis. So you can uh have a more clear idea where exactly uh those bone cancers would be both would present with a painful mass. And again, sarcoma patients might also have some systemic symptoms. X-ray f usually the Children will first have a uh an x-ray of the relevant area where they have the uh the painful mass. So, in osteosarcoma, the characteristic finding is the K triangle which I have, I include the picture here, which uh is what the common common triangle finding is. Then later on, they might have an MRI to further, um, uh, state and analyze the tumor and a common finding is higher in the blood. And some people may have a biopsy as well for investigations for sarcoma. Again, they'll first have, when they present with, uh, with a painful mass was, uh, the first have a, an X ray of course. And the characteristic finding in the urine sarcoma is a non skin electric lesion. And here we have the, uh, on the top, right, the characteristic of sarcoma later on, if, uh, the, the x-ray is suspicious for, um, a sarcoma may have an, an MRI again, similar to a coma CT for metastasis as you sarcoma can, unfortunately, metastasize to other organs. Commonly the lungs and a biopsy can, again, uh, might again be indicated in some cases management for both uh of these uh, bone, bone cancers surgery and chemotherapy are both, um, can both be, can both be used depending uh on the case. So let's go on now to uh the manter and see. Uh, we have five questions. So we'll go through them uh together first and, uh, so we'll read the question together and then I'll give you a bit of time to, to answer and then we'll go through the correct answer. So you can log into the, to ment, be great. Give you a few seconds. Yeah. Ok. I think if, uh, I'll start with the questions and then if someone hasn't been able to log in, they can let me know and I can go back and, uh, give you the code again. So let's start with the first b, so we have, um, a one year old child which presents to the medicine department being drowsy and with multiple bruises about his body, including on his head. After examining the child and taking his from his mother, the doctor suspects, taking baby syndrome, which is the correct triad of the, of the syndrome. So I'll give you a, a half a minute or uh to start the, to start for this question and then we'll see if we need more. So have a think uh read the options and answer. I just go on up in the revolting one moment. Yeah. Ok. So, ok, so uh start voting. Yeah, I'll have give 10 more seconds and then uh we'll discuss it together. Doing great. Great. So let's see the correct answer. So the correct answer is actually uh c so subdural hematomas, retinal hemorrhoids, encephalopathy is the correct answer. So this is just uh being able to remember um the correct triad and it can be tricky. And so hopefully, uh and this will be a good reminder of this question. Let's go back to the mm OK. So this was the correct answer. Uh option C let's move on now to a second b. So the point of five month old girl called it to be practice because the child just had a seizure. The seizure lasted approximately four minutes and the patient has had a fever and mild, mild upper respiratory symptoms for the last two days after the seizure. The girl quickly recovered to your presure state and did not exhibit any focal neurologic deficit. What is the main reason the patient needs a pr assessment? So option, the first option is is your duration. Second one is presence of fever and mild upper respiratory symptoms. Third is female sex. Four is a quick recovery to pre your state and uh five is age of five months. So have a think go and up on the voting again. Mhm. Ok. Um Just um ok. So I think you can vote. Let me know if you can't go back to the question and have a look, we'll go over the each option and explain why the correct option is correct. Once uh you have ed, we give uh 10 more seconds deep breath. So exactly the uh co correct answer is uh eight of five months and let's go over the uh the SBA to see why this is the correct answer. So the hints that we have in this question is that the girl is uh five months old that the um seizure lasted four minutes, had fever mild up as for the symptoms for two days they recovered. Um she recovered to her previous that quickly and did she didn't have any focal neurological doctor? So the duration of the seizure, four minutes is not really concerning. So we wouldn't be really worried about that. And that is not uh some a reason to um indicate that the patient might need the pediatrician assessment, presence of fever, mild upper symptoms. Again, it is not as this is a good sign that may increases the chances that the patient had a febrile seizure. So again, this doesn't warrant a ped assessment, female sex. There wouldn't be any difference if this was a boy or now that it's a girl. And uh likewise for the fever and the mild of respiratory symptoms, the quick recovery to the pre seizure state, again, it's good and again, increases the chances of the um febrile seizure of this being a febrile seizure. However, as men, as you mentioned in the slide before, for any child that it's outside of the age range of six months and five years, then there needs to be a more detailed assessment of um why they had the the seizure to identify if there's any um where the infection going on or anything else. So is the uh five months old is the correct answer. Let's move on to sp three if there are any questions at the stage. So a four year old child presents to the medicine department with one day history of diarrhea and drowsiness. The state that they export at the uh restaurant yesterday, which they believe was undercooked. The doctor ordered some blood tests which show an elevated creatinine and decreased platelet levels. What other abnormality will probably be seen in this patient's blood test? So here we need to first identify the correct diagnosis. Um And then to, based on the great diagnosis to the use, which require combination for the uh bladder abnormality. Go on up in the voting again. Ok. Ok. Let's see. Ok. I think you can, you can both. So I'll go back to the, to the question. You do have a quick look. Ok. I'll give you around uh 20 seconds from now. Mm, 10 more seconds. Great. Going to the question. So great. And your correct answer is low hemoglobin, high and low hemoglobin, which is correct, well done. So let's go through the question together. So here we, that hints, we have to make the correct diagnosis is that the child had a one day history and drowsiness that they ate pork and that they in the bloods, they have an elevated creatinine and decreased platelet levels. So with this information, we can deduce that the most likely diagnosis is the hemolytic syndrome. So as they have the uh the diarrhea and uh they ate pork. So pork and as we said, pork is, I can commonly transmit uh the type of E coli causing uh HS and they have the, the AK uh the elevated creatinine indicating that there's an AKI going on and the decreased platelet levels as well with uh two of the. So AK and thrombocytopenia, two of the triad uh seen in hemolytic urinary syndrome. And what we need to find out now is for the third part of the triad, which is the micro angiopathic hemolytic anemia. How is this exhibited in the blood and the correct cancer as you correctly identified is a low hemoglobin. Is there is anemia and then for hemolytic anemia, just you need to remember that there's a high LDH likely to have Ogen and low hein for the reasons mentioned before that he heptoglobin binds to the free hemoglobin. Great. It's ba four. So a five year old girl presents to primary care with your parents. They report a three month history of fatigue and bruising on examination. There is mild hepatomegaly and ce adenopathy considering the most likely diagnosis, which of the following treatments is uh most likely to have. So again, we need to uh identify the um the most likely diagnosis and then decide on the treatment. I'll open the voting. OK. And you can vote, I'll go back to question. So we'll give 1 30 seconds again. No, three times. OK. So five more seconds, right? So let's see. The great answer. Great. Great answer is chemotherapy as you correctly answered. So as I assume you probably um probably found out on your own, the most likely diagnosis here is acute lymphoblastic leukemia as uh the child here um is certain age where Children often uh when patients often first present with a ll they have the um anemia symptoms, uh symptom, fatigue and the bruising due to the thrombocytopenia as the lymphoblast infiltrate the bone marrow and they, it can really work that well. And to the um um platelets and other blood cells, there's also my hepato Andy infiltration again of the liver and lymph nodes with um lymphoblasts. So the correct diagnosis is acute neoblastic leukemia. And as I mentioned before, I think for, for uh this level at this point, it's important to le to know the chemotherapy is what this will need and uh surgery will not be really indicated in this case, uh supportive therapy will not be enough. Uh radiotherapy is not used uh in this type of cancer. Chemotherapy is most fluids used and antibiotics are not indicated. Again, this is not a, a history consistent with uh with an infection. So, more chronic presentation. Now, final B, so we have a 13 year old male uh who who presents to GP surgery with worsening dull pain on his left leg for the last two months. The pa patient place forreal but denies aneurysm leg injury. After performing a lower lip exam, the doctor arranges blood test and a left knee X ray. Relevant findings include the high P and the common triangle sign on the X ray what is the most likely diagnosis? And the options are Osteomyelitis, skin sarcoma, metastatic, bone cancer, osteosarcoma, and li knee ligament injury. So, let's open the developing again, right? So I'll give you again 1 30 seconds to have a think about it and vote. Mhm. All right. Let's see what you have. Answer it. And exactly the correct answer is osteosarcoma. So let's go through, let's go over this question together. So we have the hints here that the, the patient has a worsen dull pain. So the age is an important hint as well. 13 years old has been going on for the last two months with chronic presentation and the patient denies any recent leg injury. So this steer us away from uh the knee ligament injury. Then um on then examining patient investigations don't have information about any possible uh infections. So again, this reduces the possibility that this is osteomyelitis. So now we're between urine sarcoma, metastatic bone cancer and osteosarcoma. And the information that we have been given by the stem are high AOP and they called triangle sign on the X ray. So this um lead this towards the uh osteosarcoma um compared to the sarcoma, which wouldn't really have a high p as high op is due to the osteoblasts as the osteosarcoma is from um its origin from osteoblasts. And the colon triangle is characteristic of the osteosarcoma as well. And we don't have any information about any other lesions. And else in the body. So that's why we don't really think it's metastatic bone cancer as well. Great. So, these were the ba s hopefully uh they were too difficult or a bit uh helpful to consolidate on what we went through before. So, thank you for very much for your attention and for uh coming to the session, this is my email and you can send me any questions you might have about um what I went through or um any questions you might have about uh year five or about p um anything else. And you can ask me any question. Now, of course, right in the chart or, and nutrition also, let me know, hopefully it was useful. It was mainly high conditions of Miscell, uh mice, pediatric specialties. Thank you. Um You're correct. Finally, I forgot to mention here's a feedback form. I think it was all also um I sent in the in the chart, but here I think this feedback security code works as well. So it'd be great if you were able to uh fill out the feedback, feedback forms, you can also receive a certificate. It won't take long. I'll just leave it for a few months here. You can also use the link through the chat as well. And in the meantime, you can ask me any questions you have or otherwise you're free to go. Ok? So if I have any questions, thank you very much guys for joining and hopefully use. Cool, thank you wise.