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CAH- Common presentations Flashcards

1
Q

DDx of impalpable testes

A
  • Undescended
  • Ectopic
  • Atrophy
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2
Q

Clinical features of UDT

A
  • Impalpable in 20% cases
  • 80% palpable in intra-inguinal canal or intra-abdominally
  • Often noticed by fathers i.e. when changing nappies
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3
Q

Complications of UDT

A
  • Infertility
  • Cancer - only one not altered with Rx
  • Inguinal hernia
  • Torsion
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4
Q

Rx of UDT

A

Orchidoplexy

  • After 6 months of age
  • Pull inferiorly and fixed
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5
Q

Presentation of DDH

A
  • Dislocation at birth

- Hip instability at birth or at 6-weeks or after

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6
Q

Clinical features of DDH

A
  • Leg length discrepancy
  • Barlow & ortolani tests positive
  • Assymetrical creases (groin, bum)
  • Limited or assymetrical hip abduction in older infants
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7
Q

Risk factors of DDH

A
  • Female
  • Breech
  • Intrauterine packaging disorders (multiple, 1st, large baby)
  • Increased amniotic fluid
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8
Q

Complications of DDH

A
  • Abnormal hip shape - altered gait mechanism (pain) - early onset OA
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9
Q

Rx of DDH

A
  • Bracing before 6 weeks
  • After 3 months if reducible - hip spica (cast) or surgical reduction
  • After walking age - open surgical reduction + osteotomy (shave bone)
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10
Q

What are the DDx for a child with stridor and noisy breathing?

A
  • Croup
  • Epiglottitis
  • Bacterial tracheitis
  • Inhaled foreign body
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11
Q

What is the epidemiology of pyloric stenosis?

A
  • Typically presents from 3-6wo
  • More common in boys
  • May have FHx
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12
Q

What history features suggest pyloric stenosis?

A
  • Non-bilious vomiting, progressive, projectile
  • Every feed, but child still wants to feed
  • Decreased stooling
  • Loss of weight
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13
Q

What examination features suggest pyloric stenosis?

A
  • Visible peristalsis
  • Dehydrated, scrawny infant
  • Palpable olive
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14
Q

What metabolic derangement occurs in pyloric stenosis?

A
  • Hypochloraemic, hypokalaemic metabolic alkalosis

- Paradoxical aciduria

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15
Q

What is the initial management of post-streptococcal GN?

A

Frusemide, low salt diet and fluid restriction; with UEC monitoring

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16
Q

What features are typical of irritable hip? How is it investigated and managed?

A
  • 3-8yo, no trauma, history of viral URTI
  • Otherwise well
  • Ix = US
  • Mx = rest and analgesia
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17
Q

What features are typical of Perthes disease? How is it investigated and managed?

A
  • 2-12yo (but typically 4-8yo), more common in males, 1 week history of pain and limp
  • Restricted ROM
  • Ix = x-ray
  • Mx = may include rest, regaining motion or surgery
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18
Q

What features are typical of SUFE? How is it investigated and managed?

A
  • 10-12yo in girls, 12-14yo in boys
  • ER and shortened hip with limited ROM (esp. IR)
  • Ix = x-ray
  • Mx = surgery
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19
Q

What are the DDx of anorexia nervosa?

A
  • Psychiatric: major depression, substance abuse

- Non-psychiatric: thyrotoxicosis, malabsorption, chronic infection, malignancy

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20
Q

What are the principles of the primary survey for burns management?

A
  • Airway + C-spine control
  • Breathing + supplemental O2
  • Circulation + haemorrhage
  • Disability
  • Environmental control + exposure
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21
Q

What is the appearance of a superficial burn?

A
  • Dry
  • Minor blisters
  • Erythema
  • Brisk capillary return
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22
Q

What is the appearance of a superficial dermal burn?

A
  • Moist
  • Reddened with broken blisters
  • Brisk capillary return
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23
Q

What is the appearance of a deep dermal burn?

A
  • Moist, white slough
  • Red mottle
  • Sluggish capillary return
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24
Q

What is the appearance of a full thickness burn?

A
  • Dry
  • Charrish white
  • Absent capillary return
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25
Q

What are the principles of management of obesity?

A
  • Empathise
  • Evaluate: body composition, metabolic complications and FHx
  • Educate and empower: diet and exercise goals at an aesthetic level, with the aim on long-term change
  • If fails: VLED, metformin, surgery
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26
Q

What are the key components in taking an asthma history

A
  1. Current symptom characterisation
  2. Pattern and associations/relationships of symptoms
  3. Assessment of triggers
  4. What happens during an acute attack?
  5. Assessment of home environment
  6. Other allergies
  7. FHx of asthma, allergies, eczema
  8. Past asthma diagnosis and management
  9. Assessment of severity - i.e. previous admissions
  10. Smoking history in adolescence
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27
Q

What are signs of mild/moderate asthma?

A

Can talk
Can walk/crawl
Alert

Normal RR, HR, Sats
Mild increased WOB, wheeze

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28
Q

Management of mild/moderate acute asthma

A

Salbutamol via spacer

  • 6 puffs if 6 yrs
  • Can do this every 20 minutes x 3
  • If not responsive - oral prednisolone

Ensure correct technique

Monitor for clinical improvement for 1 hour

Provide b2 agonist and discharge if adequate response

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29
Q

Signs and symptoms of severe acute asthma

A
  • Accessory muscle use, chest recession, tracheal tug
  • Cyanosis
  • Difficulty speaking
  • Lethargic, agitated - confused, drowsy
  • Sats 90 - 94%
  • Wheeze
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30
Q

Management of severe acute asthma

A
  • Salbutamol in nebuliser ‘bolus’
  • Ipratropium bromide (every 20 mins in first hour)
  • Corticosteroids within 1st hour
  • Can give magnisum sulphate IV and aminophylline if deteriorating
  • Monitor frequently to assess if severity status changes
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31
Q

Signs and symptoms of life-threatening asthma

A
  • Silent chest - reduced air entry, no wheeze
  • Exhaustion
  • drowsy/confused
  • Marked tachycardia
  • Severe resp distress or poor resp effort
  • Cyanotic
  • Bradypnoea
  • Sats
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32
Q

Management of severe acute asthma

A
  • Continuous salbutamol nebulisers with O2
  • Contact ICU immediately
  • Ipratropium bromide
  • Corticosteroids IV
  • Magnesium sulphate IV
  • May need non-invasive or invasive ventilation
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33
Q

What Ix required during acute asthma attack?

A

None!

ABG can cause further distress
CXR and spirometry not indicated

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34
Q

What is the peak incidence of testicular torsion?

A

Babies

> 13 yo

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35
Q

What are the clinical features of testicular torsion?

A

Sudden onset, severe of testicular or abdominal pain

Nausea + vomiting

May have precedent hx of intermittent pain

Scrotum may appear high riding or discoloured

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36
Q

What are the clinical features of mild head injury?

A 
-	Minor head laceration 
\+/- 
-	brief LOC 
-	1 – 2 vomits 
-	Concussion
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37
Q

What are the clinical features of moderate head injury?

A
  • Definite LOC +/- decreased consciousness but GSC > 13
  • Definite concussion
  • Normal pupils
  • +/- vomiting
  • No focal signs
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38
Q

What are the clinical features of severe head injury?

A
  • LOC at time of injury

- Poor conscious state (GCS

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39
Q

What are fracture patterns in paediatrics?

A
  1. Buckle pattern - compression inferiorly
  2. Plastic bowing - bending without breaking cortex (more like deformity)
  3. Greenstick - incomplete fracture to one side of cortex only
  4. Complete fracture
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40
Q

What are some red flags for non-accidental fracture injury?

A
  • Delayed presentation
  • Mechanism incompatible with injury
  • Vague/varying history
  • Inappropriate parental attitude or interaction with child
  • Features of FTT
  • Signs of prior injury
  • Femoral shaft fracture
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41
Q

What are common fractures in paediatrics?

A
  1. Supracondylar
    - Humeral condyles at elbow joint
    - Commonly after FOOSH
    - Peak in 5 – 8 yo
  2. Forearm
    - Greenstick, complete or plastic deformity
    - Commonly after FOOSH
    - Most common in 12 – 14 yo
  3. Toddler’s fracture
    - Undisplaced fracture without periosteal break
    - Impact or twisting injury
    - Rx - back slab
    - Common in 9mo/walking to 3 yo
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42
Q

What are features on history that suggest NAI?

A
  • Inappropriate parental response to event: vague, unconcerned, aggressive, too distressed
  • Delay in reporting injury
  • Frequent accidents
  • Multiple attendances
  • Previous injury or abuse of siblings
  • Inconsistent or implausible history
  • Acute onset social crisis or disturbance
  • Previous DHS concerns
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43
Q

What features on examination suggest NAI?

A
  • Fear or apathy towards other adults
  • FTT
  • Injuries: inconsistent with story or at unusual sites. Document all
  • Hidden injuries: examine the fundus, chest, abdomen ± anogenital regions
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44
Q

What investigations are required for NAI?

A
  • FBE and clotting studies to exclude organic causes of bruising
  • Bone scan and skeletal survey to assess for bone fractures and healing
  • If concern about head injury: CT brain
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45
Q

What is the initial management of NAI?

A
  • DHS notification (mandatory)
  • Notify and involve VFPMS
  • Dx, Tx and document injuries
  • Admit if medically necessary or for safety reasons
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46
Q

What features on history and exam suggest neglect

A
  • FTT or developmental delay
  • Unkempt dirty appearance, sores, untreated nappy rash
  • May be abnormally affectionate to strangers (seeking human contact)
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47
Q

What are some causes/risk factors for congenital heart disease?

A
  • Syndromes, eg/ trisomy 21, 18 or 13; Fragile X, midline defects (VATER)
  • Maternal DM, rubella, PKU, SLE
  • Maternal thalidomide, retinoic acid, lithium, SSRIs
  • Maternal alcohol or marijuana
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48
Q

What are some types of cyanotic heart disease?

A
  • ToF

- TGA

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49
Q

What investigations should be performed to diagnose congenital heart disease?

A
  • Echocardiogram (gold standard)
  • CXR
  • ECG
  • ABG
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50
Q

When a child needs emergency transportation, what should be done while waiting for this service to arrive?

A
  • Resuscitation (ABC), keep warm and monitor glucose
  • Nil by mouth
  • 2x IV lines
  • Give fluid resuscitation ± low dose inotropes as indicated
  • If CHD: trial of PG (will work if duct-dependent)
  • Consider need for Abx
  • Monitor for need to intubate
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51
Q

What are the main features of ASD?

A

1/ Impaired social interactions
2/ Impaired communication
3/ Restricted behaviour and interests
4/ Onset before 3yo

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52
Q

What are some examples of impaired social interactions in ASD?

A
  • Impaired eye gaze
  • Lack of social reciprocity
  • Limited social smile
  • Poor use of gestures
  • Poor/absent joint attention
  • Limited/absent peer relations
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53
Q

What are some examples of impaired communication in ASD?

A
  • Language delay (commonly receptive)
  • Echolalia
  • Difficulties in pragmatic language
  • Lack of pointing
  • Lack of imaginative play
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54
Q

What are some examples of restricted interests/behaviours in ASD?

A
  • Abnormal preoccupations and activities
  • Delayed imaginative and social imitative play with limited interests
  • Repetitive play
  • Difficulties with change
  • Stereotyped mannerisms
  • Over- or under-reaction to stimuli
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55
Q

What are some conditions associated with ASD?

A

Epilepsy, ADHD, sleep disturbance, mental health issues

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56
Q

What are some DDx of ASD?

A
  • Specific language delay
  • ID/GDD
  • Severe hearing impairment
  • Child neglect/abuse
  • Epileptic encephalopathy (RARE)
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57
Q

Are investigations routine in the assessment of ASD? What might you consider doing?

A

Investigations are no longer routine but may consider:

  • Karyotype
  • Chromosomal analysis
  • Fragile X DNA test
  • Hearing assessment

Uncommonly: EEG, MRI, metabolic studies

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58
Q

What is the Mx of ASD?

A
  • Multidisciplinary care with early intervention strategies for management of behaviour and disabilities
  • Parent education
  • Drugs for behaviour as indicated, eg/ SSRI for anxiety
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59
Q

DDx of midline neck lump in children?

A
  • Thyroglossal duct cyst
  • Dermoid cyst
  • Submental LN/abscess
  • Goitre
  • Ectopic thyroid
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60
Q

DDx of lateral neck lump in children?

A
  • Cystic hygroma

- Branchial cleft remnants (fistula, sinus, cyst)

61
Q

What are the features of classical appendicitis?

A
  • peri-umbilical pain that migrates to the RIF ± vomiting and anorexia
  • Lying still, pallor, fetor, fever, RIF guarding (McBurney’s point), tachycardia
  • Psoas sign: pain on hip extension
  • Obturatory sign: pain on hip IR
62
Q

What are the features of retrocaecal appendicitis?

A
  • Vague, non-localising RIF pain with deep RIF tenderness

- DDx = mesenteric adenitis

63
Q

What are the features of pelvic appendicitis?

A
  • Lower abdominal pain and tenderness
  • Urinary Sx and small volume diarrhoea
  • DDx = gastroenteritis
64
Q

What are the features of a perforated appendix?

A
  • Generalised peritonitis

- Typically younger

65
Q

How might a child

A
  • Lying very still, refuses to be cuddled

- Rapid progression to perforation

66
Q

How do you diagnose and what is the management of appendicitis?

A
  • Dx on US
  • Correct dehydration and electrolyte disturbance
  • Appendicectomy
67
Q

What are the complications of a appendicectomy?

A
  • Wound infection
  • Intra-abdominal collection
  • Bowel obstruction
68
Q

What is first line treatment for enuresis?

A

Pad and bell alarms

69
Q

What diseases are associated with pathological lead points in intussusception?

A
  • Meckel’s diverticulum
  • Polyps
  • Vascular malformations
  • Duplication cysts
70
Q

What is the pathophysiology of intussusception?

A
  • Intussusceptum (proximal bowel) invaginates into the intussuscipiens
  • Commonly due to inflamed Peyer’s patches in terminal ileum
  • Leads to dehydration, bowel obstruction, ischaemia and perforation
71
Q

What are the clinical features of intussusception?

A
  • Colicky abdominal pain
  • Vomiting: gastric –> bilious
  • Lethargy
  • Red currant jelly stool (LATE)
  • Pale and diaphoretic
  • Dehydration
  • Palpable mass (early)
72
Q

What is the main Ix and finding in intussusception?

A

US: target sign

73
Q

What is the Mx of intussusception?

A
  • Air enema (if simple)

- Surgery

74
Q

What does VACTERL stand for and what is it related to?

A

Associated anomalies:

  • Vertebral
  • Anorectal
  • Cardiac
  • Tracheal
  • Oesophageal
  • Renal
  • Limb
75
Q

What is the first aid management of a seizure?

A
  • Protect the patient: move objects away from them, soft object under head, loosen anything around the neck
  • Time the seizure
  • Do not put anything in their mouth
  • Do not retrained them
  • When finished: recovery position, 000
76
Q

What are some causes of GDD?

A
  • Chromosomal abnormalities: Down syndrome, Fragile X
  • Prenatal injury: teratogenic drugs, infection, FAS
  • Perinatal injury: hypoxic-ischaemic insult –> CP
  • Postnatal injury: meningitis, NAI/neglect
  • CNS malformations: NT defects, hydrocephalus
  • Hypothyroidism
  • Inborn errors of metabolism
  • Neurodegenerative syndromes
  • Neurocutaneous syndromes (eg/ tuberous sclerosis)
  • Autism
  • Idiopathic
77
Q

What is the classical presentation of coeliac disease?

A
  • Poor weight gain in first 2 years
  • Chronic diarrhoea
  • Anorexia, apathy, abdominal distension
78
Q

What tests are required for the diagnosis of coeliac disease?

A
  • tTg IgA Ab and total serum IgA
  • Small bowel biopsy (gold standard)
  • Consider stool MCS, FBE and iron
79
Q

Differentials of language/speech delay? How do you differentiate these?

A
  • Autism, will have a triad of impairments:
    ○ Social interactions
    ○ Communication (verbal and non-verbal)
    ○ Imagination with a rigidity of though and behaviour (eg/ stereotypic mannerisms and an insistence of sameness)
  • Hearing impairment: impaired speech but appropriate non-verbal communication and will be normal in other developmental domains
  • Specific language delay: no delays in other developmental domains
  • Global developmental delay: delays in other developmental domains
  • Severe social deprivation: identified from history and may exhibit a range of delays depending on the circumstances
80
Q

A spiral fracture of the humerus is characteristic of what type of injury?

A

NAI

81
Q

What are the contraindications for LP?

A
  • Signs of raised ICP: lethargy, drowsiness, focal signs
  • Cardiorespiratory compromise
  • If meningitis is clinically evident and would give Abx despite CSF results
82
Q

What are the classical findings of Kawasaki’s disease?

A

Runny nose, fever, cervical lymphadenopathy, rash, conjunctivitis. No response to Abx

83
Q

What Ix diagnoses Hirschsprung’s disease?

A

AXR

84
Q

What are some triggers for eczema?

A

Saliva, chemicals, detergents, water, food and environmental allergies, food intolerance, animal dander

85
Q

What are the principles of eczema management?

A
  • Adequate skin care: emollients, topical steroids for flares, wet dressings ± tar
  • Environmental manipulation: reduce heat, improve dryness, avoid irritating clothes
  • Avoid triggers
  • Adequate Tx of flares: removal of crusts, oral Abx if needed, bleach and salt baths
  • Eczema Mx plan and education
86
Q

What are the causes of FTT?

A
  • Inadequate caloric intake/retention, eg/ inadequate nutrition, structural causes, GI pain, anaemia of chronic disease
  • Inadequate absorption: coeliac disease, CLD, CF, CMPA
  • Excessive utilisation: chronic illness, UTI, CF, CHD, DM, hyperthyroid, malignancy
  • Psychosocial factors: neglect/abuse, poverty, difficult chuld
87
Q

What features on history would you look for in FTT?

A
  • Feeding and nutritional Hx: what? How often? Amount? Breastfeeding or solids?
  • Intercurrent illnesses
  • Systems screen
  • DD or regression
  • Dirty or wet nappies: how many? Changes?
  • Social work or DHS involvement
  • Immunisations, allergies
  • FHx: maternal depression? Growth delay? Illnesses? Consanguinity?
88
Q

DDx of an irritable baby

A
  • Physiological
  • Infant colic
  • GIT: GOR/GORD, CMPA, lactose intolerance
  • Psychosocial neglect
89
Q

What is the Mx of infant colic?

A
  • Reassurance that child is healthy
  • Prevent exhaustion, encourage short respites
  • Soothing music with parental interaction
  • Regular follow up
90
Q

C/I for circumcision

A

Hypospadias

91
Q

Complications for circumcision

A
  • Bleeding
  • Infection
  • Ulceration of glands and meatus
  • Penile deformity
  • Acute urinary retention
92
Q

Indications (medical) for circumcision

A

Phimosis, paraphimosis, recurrent balanitis, recurrent UTIs

93
Q

Initial Ix when for childhood obesity

A

Fasting glucose and OGTT
Lipid profile
TFTs
LFTs

94
Q

Definition of short stature

A
95
Q

Initial Ix for short stature? What do you want to rule out?

A

Ix = FBE, TFTs, UEC, ESR and tTg Ab, IGF-1, hand and wrist x-ray

Want to rule out: true GH deficiency, hypothyroidism and Turner’s

96
Q

When is puberty considered precocious?

A
97
Q

When is puberty considered delayed?

A

> 14yo in girls, >15yo in males

98
Q

What investigations should be ordered when assessing developmental delay?

A 
Karyotype/microarray
FMR1 triplet repeat
FBE, UEC, LFTs
TFTs
Urine metabolic screening and mucopolysaccharide screen
CK in boys
99
Q

What is the definition of cerebral palsy?

A

Group of disorders of development of movement and posture due to non-progressive insults on the developing fetal/infant brain. Often accompanied with sensory, cognitive, communication, perception and behaviour disturbances ± epilepsy and orthopaedic complications

100
Q

What are common features of cerebral palsy?

A

Tone disorder
Spasticity, dystonia
Deformity, contracture

101
Q

What is the most common genetic cause of moderate intellectual impairment?

A

Down’s syndrome

102
Q

What disease commonly affects people with Down’s syndrome in their 40s?

A

Alzheimer’s disease

103
Q

What is the nucleotide repeat in Fragile X?

A

CGG

104
Q

Chance of recurrence in Down’s syndrome?

A

1%

105
Q

Chance of recurrence in Fragile X?

A

25%

106
Q

Prevalence of autism spectrum disorder?

A

1/160

107
Q

Risk of recurrence of ASD?

A

5-10%

108
Q

Definition of enuresis?

A

Wetting while asleep after 5yo

109
Q

What is monosymptomatic enuresis?

A

Night wetting without daytime urinary symptoms

110
Q

What is believed to be the pathophysiology of enuresis?

A

1- High nocturnal urine output
2- Small nocturnal functional bladder capacity
3- Poor arousal from sleep with full bladder

111
Q

At what age do you treat enuresis?

A

7yo (10yo is a red flag)

112
Q

At what age do you treat day wetting?

A

4yo

113
Q

What Ix is used to diagnose an overactive bladder (day wetting)?

A

Uroflow

114
Q

What Ix is used to diagnose dysfunctional voiding (day wetting)

A

Post-residual void US

115
Q

What is the Mx for an overactive bladder (day wetting)?

A

Oxybutynin

116
Q

What is the Mx for an dysfunctional voiding (day wetting)?

A

Urotherapy: regular voiding, pelvic floor relaxation, posture, check bowels

117
Q

What is the Mx for dysfunctional elimination syndrome?

A

Fix bowel first, then overactive bladder then nocturnal enuresis with urotherapy for tough cases

118
Q

At what age can faecal incontinence be diagnosed?

A

4yo

119
Q

Pathophysiology of constipation-associated faecal incontinence

A

Withholding
Increased volume and pressure in rectal ampulla
Chronic stretching of rectal ampulla
Rectal hyposensitivity
Intermittent relaxation of external anal sphincter
Unexpected faecal leakage

120
Q

Mx of faecal incontinence

A

Toileting tailored program: maximise emptying and sensation
Laxatives for initial clear out ± maintenance
Posture: feet supported, knees above hips, legs apart, bulge tummy
Removal barriers and add rewards

121
Q

At what age should solids be introduced?

A

4-6mo

122
Q

When is low fat milk appropriate for children?

A

From 2yo

123
Q

What influences growth and development?

A

Genetics

Environment - culture, education, attitudes

Pregnancy - maternal BP, drug/smoking, health status, infection

Perinatal - hypoxia, delivery, prematurity

Postnatal - infection, illness, nutrition

Intrapersonal - personality, birth order, parental bond

124
Q

When is bowel and bladder control typically achieved?

A

2-4yo (unless night-time bladder control = 5-7yo)

125
Q

Most common cause of persistent stridor in infants?

A

Laryngomalacia

126
Q

Most common causative agent of croup?

A

Parainfluenza type 1

127
Q

Most common causative agent of bronchiolitis?

A

RSV

128
Q

Most common cause of pneumonia in paediatric populations?

A

Viruses

129
Q

Most common cause of chronic cough in paediatrics?

A

Protracted bacterial bronchitis

130
Q

What disease may SUFE be associated with?

A

Endocrinopathy or metabolic abnormalities: hypothyroidism, hypogonadism, GH abnormalities, panhypopituitarism, renal osteodystrophy

131
Q

Congenital heart disease: fixed splitting of S2

A

ASD (systolic, LUSE)

132
Q

Congenital heart disease: pan-systolic murmur at LLSE, radiating to back and axilla

A

VSD

133
Q

Congenital heart disease: premature newborn with prolonged ventilation requirement

A

PDA

134
Q

Congenital heart disease: ejection click at LUSE

A

PS

135
Q

Congenital heart disease: click at RUSE

A

AS

136
Q

Lesions in ToF

A

VSD, RH hypertrophy, PS

137
Q

Dietary advice in iron deficiency

A

Breastfed infants >4-6mo often require additional iron

Limit cow’s milk to children >12mo and

138
Q

A/E of ferrous iron salts

A

Black stools, constipation

139
Q

Commonest cause of limp in pre-school age group

A

Transient synovitis of the hip

140
Q

Most likely cause of limp in an overweight, early adolescent child

A

SUFE

141
Q

Exomphalos is what genetic disease UPO?

A

Beckwith-Wiedemann syndrome

142
Q

What medications can be used for angina prophylaxis?

A

1st line = beta-blockers
2nd line = non-dihydropyridine Ca blockers (verapamil, dilitazem)

Consider long acting nitrates
Consider SA-nitrates before exercise

143
Q

What are the most common causes of UTI in complicated vs. non-complicated?

A

Complicated - E.coli (70-95%), S. saprophyticus (5-10%)

Uncomplicated - E.coli (20-50%), proteus, klebsiella, enterococci, group B strep

144
Q

Should asymptomatic bacteuria be treated?

A

No - unless pregnant or undergoing urological surgery

145
Q

What is the Rx for UTI?

A

1st line = trimethoprim
2nd line = cephalexin (1st gen ceph)
3rd line = co-amoxyclav OR nitrofurantoin

In pregnancy do not use trimethoprim (teratogenic)
1st line = Cephalexin OR nitrofurantoin

146
Q

What is the difference in antibiotic course length for men vs. women?

A

Men need a longer course ~7 days

Women need only ~3-5 days

147
Q

When should UTI be Ix further?

A

All men should be examined (including DRE) and investigated as cause is likely due to anatomical or functional GUT abnormality

148
Q

What are considerations for UTI in paediatrics?

A

If suspected UTI always take urine culture and start empirical antibiotics

Suspect if symptoms of UTI, positive leucocyte esterase or nitrites on urinalysis

UTI in kids usually acute pyelonephritis but can be difficult to distinguish with acute cystitis clinically
- if fever or loin pain/tenderness treat as pyelonephritis

149
Q

What is the Rx for UTI in kids?

A

1st line = trimethoprim + sulfamethoxazole OR trimethoprim
2nd line = cephalexin
3rd line = co-amoxyclav

If pyelonephritis as per cystitis but longer oral course of 7-10 days or if serious IV gentamycin + amoxicillin

All infants

MD3 (21 decks)

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