Capsule - Mixed Flashcards
What is included in a baby septic screen?
Bloods, LP, urine dipstick
What bacteria level is a UTI confirmed?
> 10^5 colony of urine
What is the most common UTI bacteria?
E. coli
When is a DMSA scan required in children with UTI?
Klebsiella UTI <6 months old - atypical UTI
Ix for UTI in under 6 months old
USS urinary tract
Ix for atypical UTI
USS urinary tract acutely
DMSA scan after 4-6 months if under 3
MCUG if under 6 months old
Features of atypical UTI
Seriously I’ll
Septic
Poor urine flow
Abdo or bladder mass
Raised serum creatinine
Non E. coli
Ix recurrent UTI
USS urinary tract
DMSA 4 to 6 months later
MCUG if under 6 months
What is vesicouretic reflux?
Incompetent valve at vesicouretic junction allowing reflux of infected urine to kidneys
How common is vesicouretic reflux?
30%
Complication of vesicouretic reflux
Pyelonephritis and renal scaring
How do you confirm vesicouretic reflux?
Micturating cystourethrogram following uti
Mx of vesicouretic reflux
Long term abx and surveillance
Age peak of pyloric stenosis
4-6 weeks
What is pyloric stenosis
Hypertrophy of pylorus
Sx of pyloric stenosis
Projectile vomiting during or just after feeding
Hungry immediately after vomiting
Constipation
Sex preference in pyloric stenosis
Male 7:1
Physical examination findings of pyloric stenosis
USS prior to Sx
Weight loss, dehydration
Visible peristalsis of stomach
Olive sized tumour in RUQ
What blood features are found in pyloric stenosis
Hypocholoraemic alkalosis with low K and Na
Mx of pyloric stenosis
Rehydration
Surgical correction
What surgery is done in pyloric stenosis s
Ramstedt procedure - slice through pyloric muscle
What is the most important thing to remember in testicular torsion Mx?
The other testicle has an increased risk of torsion
Ix for testicular torsion?
NONE - do it clinically as quick as possible
Can have USS but do not wait for this
Causes of undescended testes?
Incompetent descent of testes
Hypopituartism
Sx of cryptorchodism?
No Sx
Impalpable testes or high in scrotum / inguinal region
Risks of cryptorchidism?
Malignancy and infertility
Mx of cryptorchidism?
Orchidoplexy
Age peak intussusception ?
3 months to 2 years
Most common type of intussusception
Ileo-caecal
Sx of intussusception
Episodic screaming but comfort between attacks
20% apathetic or encephalopathy
Passage of red current jelly stool
Physical examination of intussusception
Pallor
Sausage shaped mass on R abdo
Blood on PR
Ix of intussusception and findings
AXR - dilated small bowel loops
USS - invaginated bowel
Mx of intussusception
Reduction by air or contract enema
Surgery
When do you find the red current jelly stool in intussusception
LATE in the course
Ddx of intussusception
Any acute painful illness eg otitis media or appendicitis
Features of haemolytic uraemic syndrome?
Renal failure / nephropathy
Microangiopathic haemolytic anaemia
Thrombocytopenia
What causes HUS
E. coli 01571 H7 - from petting zoo
Sx of HUS
Abdo pain jaundice bloody diarrhoea Anuria oedema
Ix of HUS
FBC clotting renal func stool culture BP fluid balance and daily weights
Complications of HUS
Encephalopathy and pancreatitis
Tx of HUS
Dialysis fluid management red cell transfusion antihypertensives
Prognosis of HUS
5% death and 25% long term sequaelae
Features of measles
Cough, Coryzz, rash, fever, koplik spots in mouth, conjunctivitis
Incubation of measles
10-14 days
Measles complications
Otitis media, subacute sclerosing pan encephalitis , pneumonia and encephalitis
Molluscum features?
Red bumps with central punctum
Age peak for febrile seizures?
6 months to 6 years
How long are febrile seizures?
Few minutes
3 bacteria that cause otitis media
Streptococcus
Haemophilus influenza
M. catarrhalis
Worrying features of febrile seizures
Unilateral symptoms
Long lasting seizure
Raised ICP red flags
Worrying features of headache suggesting serious intracranial pathology
Deterioration of handwriting
New squint
Ataxia
Waking in night with pain
Early morning vomiting with headache
How is BR produced?
Breakdown of RBCs
How does unconjugated BR circulate?
With albumin
Where is BR conjugated?
Liver
What does BR cause in body?
Brown poo and yellow wee
Is conjugated hyperBR pathological or not?
ALWAYS pathological
Is <24hr old with hyperBR pathological or not?
ALWAYS pathological
What can hyperBR in baby cause?
Kernicterus
What is kernicterus?
Athetosis
High risk of CP
High risk of sensorineural deafness
What signs are present in baby in biliary atresia?
Dark urine, pale stools