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*Phase 3a Julia > Child's health > Flashcards

Child's health Flashcards

1
Q

When does ductus arteriosus close?

A

Day 2 of life

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2
Q

What congenital heart defect is seen in Down’s Syndrome?

A

cAVSD (complete)

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3
Q

What genetic syndrome is coarctation of the aorta associated with?

A

Turner syndrome (45, X)

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4
Q

what does CPAP stand for?

A

Continuous Positive Airways Pressure

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5
Q

What is long QT syndrome often mistakenly diagnosed as in children?

A

Epilepsy

Long QT syndrome is associated with sudden LOC during exercise, stress or emotion

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6
Q

Features suggestive of a cardiac cause of syncope:

A

Symptoms on exercise - potentially dangerous
FH of sudden unexplained death
Palpitations

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7
Q

Infecting agent in Rheumatic fever?

A

An abnormal immune response to infection with Group A haemolytic streptococcus

(same that causes tonsillitis)

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8
Q

What causes leukaemia?

A

When a white blood cell starts multiplying out of control

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9
Q

List the white blood cells

A

Lymphoblasts (B lymphocytes, T lymphocytes)

Granulocytes (eosinophiil, neutrophil, basophil)

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10
Q

What does ALL result from?

A

Infiltration of the bone marrow or other organs with leukaemic blast cells

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11
Q

What CFs does bone marrow infiltration present with?

A

ANAEMIA: pain, lethargy

NEUTROPENIA: infection

THROMBOCYTOPENIA: bruising, petechiae, nose bleeds, bone pain

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12
Q

What are the CFs as a result of the reticulo-endothelial infiltration in ALL?

A

hepatosplenomegaly

lymphadenopathy

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13
Q

What are the CFs as a result of other organ infiltration in ALL?

A

CNS: headaches, vom, nerve palsies

Testicular enlargement

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14
Q

Why might ALL present like meningitis?

A

Petechiae ‘rash’ (from the easy bruising in ALL).

  • But this would actually be meningococcal septicaemia as is this as soon as there is a rash!
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15
Q

Ix ALL:

A

BLOOD COUNT:

  • anaemia
  • WCC up or down
  • neutropenia
  • thrombocytopaenia
  • blast cells

BONE MARROW
LP

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16
Q

Peak age ALL

A

4-7yrs

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17
Q

Prognosis ALL

A

80%

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18
Q

Good prognostic factors ALL

A

Age 2-10
Female
WCC <50
No CNS disease

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19
Q

ALL classification:

A

Common

B and T cell

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20
Q

ALL treatment

A

Stratified into risk groups A B & C

Consolidation and CNS treatment
Intensification
Maintenance (girls 2yrs, Boys 3yrs)

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21
Q

Causes of macrocytic anaemias

A

Vitamin B12 deficiency (including pernicious anaemia)

Folate deficiency

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22
Q

Causes of microcytic, hypochromic anaemia:

A

Iron deficiency

Thalassaemia

Chronic inflammatory disease

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23
Q

What does a low reticulocyte count mean?

A

Lack of production

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24
Q

What does a high reticulocyte count mean?

A

Haemolysis / blood loss

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25
Q

Causes of anaemia classified by mechanism:

A

decreased production
increased consumption
increased loss

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26
Q

Tx Sickle cell disease

A

Pneumococcal, influenza, meningococcal vaccines

Prophylactic penicillin

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27
Q

What infection might cause aplastic crisis in sickle cell disease?

A

Parvovirus B19

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28
Q

What presents with a large abdo mass, haematuria, anorexia, fever?

A

Wilms’ tumour

A nephroblastoma

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29
Q

2 paediatric bone tumors and which is most common?

A

Osteogenic sarcoma (more common)

Ewing Sarcoma

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30
Q

What do neuroblastomas arise from?

A

Neural crest tissue in the adrenal medulla and SNS

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31
Q

Raised levels of what in the urine are suggestive of neuroblastoma?

A

Catecholamine levels

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32
Q

CFs brain tumour

A

Behaviour change, tired, raised ICP, focal neuro

Headache (worse lying down)
Vomiting (esp on morning waking)
Papilloedema
Squint
Nystagmus
Ataxia
Personality change
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33
Q

Whats the most common brain tumour type? and where?

A

Astrocytoma

Cortex, hypothalamus, thalamus

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34
Q

Diagnosis of Kawasaki disease?

A

CRASH and BURN (Fever >5 days) + other features
Conjunctivitis (bilateral + non-purulent)
Rash
Adenopathy (cervical + unilateral)
Strawberry tongue + cracked lips
Hands / feet – erythema + desquamation

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35
Q

What is Kawasaki diseae?

A

A systemic vasculitis

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36
Q

Ix Kawasaki disease

A 
FBC: 
High platelets (thrombocytosis) ,

echo (inpatient) and one at 6 weeks to look for cornary artery aneyursms

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37
Q

Mx Kawasaki

A

Mx: oral aspirin, (anti-inflamatory, antiplatelet agent

IV immuniglobuin (dampens down immune response to vasculitis)

Echo inpt and cardio referal (for echo 6 weeks later)

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38
Q

Causes of neonatal collapse

A
  1. ** Sepsis
  2. Cardiac (duct dependent lesion)
  3. PPHN
  4. Metabolic
  5. NIA
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39
Q

What causes PPHN?

A

a. Meconium aspiration
b. Infection (from PROM, group B strep carrier)
c. Congentical abnormalities of the heart and lungs

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40
Q

What happens in PPHN?

A

is a condition caused by a failure in the systemic circulation and pulmonary circulation to convert from the antenatal circulation pattern to the “normal” pattern.

In a fetus, there is high pulmonary vascular resistance and low pulmonary blood flow as the fetus does not use the lungs for oxygen transfer. When the baby is born, the lungs are needed for oxygen transfer and need high blood flow which is encouraged by low pulmonary vascular resistance.

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41
Q

Management of neonatal collapse

A

Airway / breathing

  • intubation and ventilation
  • NG tube

Circulation

  • Lines (UAC/UVC/peripheral cannula)
  • Fluid resus (10 mls/kg 0.9% NaCl)
  • Inotropes (dopamine/dobutamine)

Disability

  • Glucose (2mls/kg 10% glucose if hypoglycaemia)
  • Assess neurology (think about therapeutic hypothermia)

Investigations
- CXR/AXR, Echo, FBC/CRP/cultures

Antibiotics

Treat underlying cause

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42
Q

What is bronchiolitis and what age group does it occur in?

A

Acute infection of lower airways

The very young (usually <1yr)

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43
Q

What classically causes bronchiolitis?

A

Respiratory Syncytial virus (RSV)

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44
Q

CFs bronchiolitis

A

Coryzal symptoms (including mild fever) precede:

  • dry cough
  • increasing breathlessness
  • wheezing, fine insp crackles (not always present)
  • feeding difficulties associated with increasing dyspnoea
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45
Q

Mx Bronchiolitis

A

O2
Support feeds
Patience

POSSIBLY

  • Respiratory support (high flow, CPAP, intubation + ventilation)
  • Nebulised adrenaline

–>supportive care

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46
Q

What is a NPA and why is it useful in bronchiolitis?

A

Nasopharyngeal Aspirate (to diagnose causative agent)

Useful to avoid other investigations and to decide if need segregate kids if in ITU (RSV is highly contagious)

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47
Q

What is sepsis?

A

Dysregulated host response leading to end organ dysfunction (hypotension, tachycardia etc.)

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48
Q

Causative agents in sepsis?

A

Meningococcal disease (caused by neisseria meningitidis)

Streptococcal Group A infection

(in neonates: GBS)
(Also can be viral, fungi, parasites)

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49
Q

Ix for sepsis

A 
FBC
U&amp;Es
LFTs
CRP
Cultures
Gas (including lactate)
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50
Q

Mx sepsis

A
  • O2 to keep sats >94%
  • Fluid resus: 20ml per kilo, 0.9% saline
  • Broad spectrum Abx : cefotaxime
  • Appropriate escalation: intensive care, inotropes
  • DIC: FFP + platelet transfusions
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51
Q

What do inotropes do?

A

Incrased the strength of mucscular contraction

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52
Q

What is asthma?

What age?

A

Reversible airways obstruction

Usually >5 yrs of age

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53
Q

To assess control + Hx of asthma, what 4questions to ask?

A
  • How often are you using blue inhaler?
  • How many courses of oral steroids in last 6 months?
  • Hospital admissions etc.?
  • Have you ever been to intensive care?
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54
Q

Treatment of acute asthma ?

A
  1. Bronchodilators: salbutamol (10 puffs via spaces), or ipratropium if on O2
  2. Steroids: oral steroids if theyre ok, IV hydrocortison if a bit sicker

Rarely: magnesium, aminophyline, salbutamol IV - if you do that they need to go to ITU

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55
Q

What to check acute asthma inpt before you send them home?

A

Check inhaler technique
Compliance with their meds
Are you sure you’re taking the brown one everyday? (beclamethasone)

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56
Q

What are the cardiac causes of neonatal collapse?

A

Duct dependent systemic lesions:

  • Coarctation of the aorta
  • Critical aortic stenosis

Duct dependent pulmonary circulation

  • Pulmonary atresia
  • TOF

Both: TGA

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57
Q

Normal value of pH

A

7.35 - 7.45

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58
Q

Normal value of pO2

A

10 - 14 kPa

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59
Q

Normal value of pCO2

A

4 - 6 kPa

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60
Q

Normal value bicarbonate

A

HCO3-

22 - 26

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61
Q

Normal base excess

A
  • 2 to + 2
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62
Q

Normal lactate value

A

< 2

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63
Q

What conditions might cause Respiratory Acidosis?

A

Inefficient ventilation: asthma, pneumonia, bronchiolitis, preterm neonates

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64
Q

What condition might cause Respiratory Alkalosis?

A

Hyperventilation (and tingling fingers)

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65
Q

What conditions might cause Metabolic acidosis?

A

Sepsis, DKA

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66
Q

What conditions might cause Metabolic Alkalosis?

A

Profuse vomiting, Diuretics

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67
Q

Causative organism scarlett fever?

A

Group A strep

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68
Q

CFs (general) scarlet fever

A

sudden fever
sore throat
red strawberry tongue

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69
Q

CFs (progression) scarlet fever

A

Skin = sandpaper-like feel

Pastia lines = red streaks in body folds

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70
Q

Mx scarlet fever

A

Oral penicilin for 10 days

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71
Q

Complications scarlet fever?

A 
Rheumatic fever
Otitis media
Pneumonia
Septicaemia
Glomerulonephritis
Death!
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72
Q

Causitive agents in meningitis?

A

Neisseria meningitidis

Group B strep

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73
Q

Community Mx of meningits?

A

IM benzylpenicilin

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74
Q

What is given to prevent hearing loss from meningitis?

A

Dexamethasone

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75
Q

What are the causes of breathless congenital heart disease? And what direction is the shunt?

A

ASD
VSD
PDA

L –> R

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76
Q

What are the causes of cyanotic congenital heart disease? And what is the direction of the shunt?

A

5Ts:

  1. Truncus arteriosus
  2. ** Transposition of the great arteries
  3. ** Tricuspid atresia
  4. Tetralogy of fallot

R –> L

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77
Q

What is the most common congenital heart defect?

A

VSD

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78
Q

CFs VSD?

A

Tachycardia
Tachyopnea
FTT
HF

**Pansystolic murmur (L lower sternal edge)

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79
Q

Mx VSD?

A

Small: will close spontaneously

Large: surgical closure + diuretics

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80
Q

CFs ASD?

A

Commonly none
Tachypnoea
FTT
Wheeze

**Ejection systolic murmur (L upper sternal edge)

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81
Q

What does the DA connect?

A

The aorta to the pulmonary artery

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82
Q

CFs PDA

A

Tachypnoea
FTT
Bounding pulse

**Continuous machine-like murmur (below L clavicle)

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83
Q

Mx ASD?

A

Small: will close spontaneously
Large: surgical closure

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84
Q

Mx PDA

A

NSAIDs (ibuprofen - to close)

or

Surgical ligation

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85
Q

4 components tetralogy of fallot?

A
  1. Pulmonary stenosis
  2. Overriding aorta
  3. VSD
  4. Right ventricle hypertrophy
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86
Q

CFs ToF

A 
Severe cyanosis
Hypercyanotic spells on: exercise, crying, defecating
Squatting on exercise
**Ejection systolic murmur
Clubbing of fingers and toes (late)
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87
Q

Mx ToF

A

Surgery at 6 months

  • Close VSD
  • Relieve pulmonary outract obstruction
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88
Q

What happens in transposition of great arteries?

A

Pulmonary artery and aorta swap (2 independent loops)

- RV -> aorta -> body -> RA
- LV -> PA -> lungs -> LA
its only the PDA keeping them alive

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89
Q

CFs Transposition of the great arteries

A

Present on day 2 of life (after DA closes) with severe life-threatening cyanosis

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90
Q

Mx Transposition of the great arteries

A

KEY: want to improve mixing
1. Maintain PDA (prostaglandin infusion)

  1. Surgical: atrial septostomy and arterial switch procedure

(to close - ibuprofen)

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91
Q

What can cardiac outflow obstruction be divided into?

A

Well child:

  • Pulmonary stenosis
  • Aortic stenosis

Sick child:
- Coarctation of the aorta

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92
Q

What happens in pulmonary stenosis?

A

Pulmonary valve leaflets partially fused together, obstructs RV outflow

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93
Q

CFs Pulmonary stenosis?

A

Asymptomatic
** Ejection systolic murmur (Left upper sternal edge)
Palpable thrill

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94
Q

What happens in aortic stenosis?

A

Aortic valve leaflets partially fused together, obstructs LV outflow

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95
Q

CFs aortic stenosis?

A

Reduced exercise intolerance
CP / syncope on exertion
Carotid thrill
** Ejection systolic murmur (R upper S.E)

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96
Q

What happens in coarctation of aorta, and where?

A

Narrowing of the aorta
Commonly at DA
Acute circulatory collapse at day 2 when duct closes –> severe obstruction to LV outflow

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97
Q

CFs coarctation of the aorta

A

Acute circulatory collapse at day 2 when duct closes:

  • sick baby w severe HF
  • absent femoral pulses
  • severe metabolic acidosis
  • BP may be arms > legs

They become more severe with age:

  • Asymptomatic
  • Then S.O.B, arterial hypertension, intermittent claudication
  • *Ejection systolic murmu (L upper S.e)
  • Radial/radial:femoral delay
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98
Q

Mx Coarctation of the aorta

A

Stent and surgical repair

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99
Q

What heart defect is more common in Turner’s syndrome? - and what is TS?

A

Coarctation of the aorta

45, X

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100
Q

What are the 4 S’s of a harmless murmur?

A

Soft
Systolic
aSymptomatic
L Sternal edge

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101
Q

Ix for a harmless murmur?

A

Antenatal ECHO

Neonatal ECHO, ECG, CXR

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102
Q

What syndrome occurs in a long-standing left-right shunt in a congenital heart defect?

A

Eisenmenger’s syndrome

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103
Q

What happens in Eisenmenger’s syndrome?

A

long standing L to R shunt increases Pul pressure over time, leading to thickening of pulmonary arteries, which causes RVH and increases pressure in RV, reversing the shunt R to L (cyanotic)

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104
Q

CFs Eisenmenger’s syndrome

A

10-15yr old, severely cyanosed

original murmur may disappear
clubbing
right ventricular failure
haemoptysis, embolism

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105
Q

Mx Eisenmenger’s syndrome

A

Heart-lung transplantation

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106
Q

CFs Rheumatic fever

A

Latent interval of 2-6 weeks following pharngeal infection

Then: polyarthritis, mild fever + malaise

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107
Q

Name of criteria for diagnosing Rheumatic fever?

A

Jones Diagnostic Criteria

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108
Q

Mx acute rheumatic fever?

A

Anti-inflammatory agents (aspirin)

Corticosteroids

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109
Q

How to prevent the recurrence of rheumatic fever?

A

Monthly injections of benzathine penicillin

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110
Q

Causative agent infective endocarditis?

A

Staph aureus

Group B streptococci

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111
Q

Causative pathogen croup

A

Parainfluenza virus

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112
Q

Age of occurence croup?

A

6mo - 6yrs.

Peak 2yrs

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113
Q

CFs Croup

A 
Barking cough (seal like)
Stridor
Hoarseness
Breathlessness
Poor feeding

Preceded by fever, worse at night

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114
Q

Mx Croup (general)

A

Oral dexamethasone

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115
Q

Mx Croup if severe (before escalation to ICU)

A

High flow O2

Nebulised adrenaline

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116
Q

Pathogens tonislitus

A

Group A beta-haemolytic strep

Epstein-Barr Virus

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117
Q

Mx tonsilitis

A

Penicilin (or erythromycin if allergic)

Hosp admission for IV fluids and analgesia if can’t swallow

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118
Q

What is acute epiglottitis

A

Life threatening medical emergency
Upper airway obstruction
Intense swelling of epiglottis and surrounding tissue

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119
Q

Causative pathogen epiglottitis?

A

Haemophilis influenzae B

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120
Q

How to diagnose otitis media?

A

Examination of the tympanic membrane:

- Bright red and bulging, with loss of normal light reflection

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121
Q

Causative pathogen otitis media?

A

Bacterial: Pneumococcal infection (caused by strep pneumoniae) or HIB
Viral: RSV + rhinovirus

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122
Q

Rx otitis media

A

Regular analgesia for 1 wk

Amoxicillin (if child remains unwell for 2-3 days)

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123
Q

CFs otitis media

A

Fever

Pain in ear

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124
Q

What can recurrent ear infections lead to? and what is its CFs?

A

Otitis media with effusion

Asymptomatic apart from reduced hearing

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125
Q

Mx OME

A

Usually resolves spontaneously

Grommets +/or adenoidectomy

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126
Q

Idications for removal of both the tonsils and adenoids

A

Recurrent OME with hearing loss

Obstructive sleep apnoea (absolute indication)

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127
Q

What is stridor

A

A rasping sound heard on inspiration

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128
Q

Mx acute epiglottitis?

A

dont examine throad

Call anesthetist to intubate
IV Cefuroxime

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129
Q

Causative organism whooping cough?

A

Bordetella Pertussis

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130
Q

Symptoms whooping cough

A

Inspiratory whoop

Spasms of cough - worse at night, cause vomiting, cyanosis, epistaxis (nosebleeds) and subconjunctival haemorrhages

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131
Q

Paroxysmal phase in whooping cough

A

3-6 wks but can persist for months (100 day cough)

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132
Q

Ix whooping cough

A

Per Nasal Swab culture

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133
Q

Mx whooping cough

A 
azithromycin
School exclusion (for 2 days after commencing Abx)
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134
Q

Epidemiology Bronchiolitis

A

Most common LRTI in children

Incidence increases in winter

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135
Q

CFs bronchiolitis

A

Coryzal
Breathlessness
Poor feedsing

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136
Q

Signs of resp distress in bronchiolitis?

A 
Nasal flaring
Head bobbing
Subcostal or intercostal recessions
Tracheal tug
Grunting
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137
Q

Other signs of resp distress in bronchiolitis

A

Fine end inspiratory crackles
High pitched wheeze
Cyanosis (on feeding)

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138
Q

Ix bronchiolitis

A

PCR analysis of nasal secretions

CXR: hyperinflation

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139
Q

Rx bronchiolitis

A

Supportive - humidified O2, NG feeds, fluids

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140
Q

Prevention for bronchiolitis

A

Palivizumab

  • monoclonal antibody
  • IM once per month through autumn and winter
  • CF, immunocompromised, congenital heart disease, Downs, preterm babies
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141
Q

Asthma pathophysiology

A

Chronic inflamatory disorder of lower airways secondary to hypersensitivity

Reversible airway obstruction:

  • bronchospasm
  • musocal swelling and inflammation
  • mucous plug
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142
Q

CFs asthma

A 
intermitted dyspnoea
wheeze
diurnal variation
sputum production
etc.
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143
Q

Dx asthma

A

clinical
FEV1:FVC <70%
bronchodilator reversibility - FEV1 improvement by 12% or more

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144
Q

What should you monitor for with IV salbutamol?

A

Hypokalaemia

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145
Q

Cystic fibrosis pathophysiology

A

Autosomal resessive defect in CFTR

  • codes cANP regulated chloride channels in cell membranes (Chr 7)
  • causes increased viscosity of secretions and blockage of narrow passageways
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146
Q

Clinical features CF

A

Reduction in air surface liquid layer & impaired ciliary function retention of secretions:
- chronic endobronchial infection - pseudomonas, staph aureus

Pancreatic ducts blocked by thick secretions –> maldigestion, malab and steatorrhea
- neonates present with meconium ileus

Later in life : DM, delayed puberty, male infertility, female subfertility

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147
Q

What do most CF pts die of?

A

Respiratory failure

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148
Q

Dx CF

A

Guthrie heel prick screening test
Sweat test (Cl ions markedly increased)
Feacal elastase (low levels)
Gene abnormalities in CFTR protein

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149
Q

Mx CF

A
  1. Aim to prevent progression of lung Dx and maintain adequate nutrition
  2. High cal, high fate diet
  3. Chest PT and postural draining
  4. Pancreatic enzyme replacement therapy (PERT)
  5. Prophylactic Abx (? flucloxacillin)
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150
Q

What infections are you especially worried about in CF?

A

Pseudomonas aeruginosa

Staphylococcal aureus

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151
Q

DDx stridor other than croup and epiglottitis?

A

Foreign body

Anaphylaxis

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152
Q

Most common cause of pneumonia in younger children?

A

Viral: RSV

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153
Q

Most common cause of pneumonia in older children?

A

Bacteria: streptococcus pneumoniae or mycoplasma pneumoniae

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154
Q

What Abx for pneumonia?

A

1stL: amoxicillin

If severe: co-amoxiclav or Cefotaxime

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155
Q

Triad in nephrotic syndrome

A

Hypoalbuminaemia
Proteinuria
Oedema (peripheral, scrotal/vulval, periorbital, ascites)

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156
Q

Common causes Nephrotic syndrome

A

Minimal change disease
Focal-segmental glomerulosclerosis
Post-streptococcal nephrities

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157
Q

Tx Nephrotic syndrome

A

Steroid sensitive: 85%-90%
- Prednisolone oral

Steroid resistant

  • Diuretics, salt restriction, ACE-I, NSAIDs
  • Cyclophosphamide +/- ciclosporin (both immunosuppresants)
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158
Q

Triad in Haemolytic Uraemic Syndrome

A

Acute renal failure
Thrombocytopenia
Haemolytic anaemia

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159
Q

What does Haemolytic Uraemic Syndrome follow?

A

A prodrome of bloody diarrhoea - E. Coli / shigella

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160
Q

CFs Haemolytic Uraemic Syndrome

A

Abdo pain
Decreased urine output
Normocytic anaemia

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161
Q

Ix Haemolytic Uraemic Syndrome

A

Fragmented blood film
Stool culture
FBC

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162
Q

Mx Haemolytic Uraemic Syndrome

A

Supportive + Dialysis

Plasma exchange if severe

163
Q

Henoch-Schonlein Purpura Triad

A

Purpura (raised like sandpaper)
Arthritis (knees and ankles)
Abdo pain

164
Q

What does Henoch-Schonlein Purpura follow?

A

URTI - Strep pyogenes (a.k.a. Group A strep)

165
Q

CFs Henoch-Schonlein Purpua?

A

Rash on buttocks and extensor surfaces of limbs
Haematuria
Proteinuria
Oedema

166
Q

Mx Henoch-Schonlein Purpura

A

Oral prednisolone

167
Q

UTI Px in infants

A

Poor feeding
Vom
Irritability

168
Q

UTI Px in younger children

A

abdo pain, fever, dysuria

169
Q

What Ix for all infants with an unexplained fever of >38 degree

A

Urine sample

170
Q

Mx UTI <3mo old

A

Immediate referral to paediatrician

IV Abx e.g. Cefotaxime

171
Q

Mx UTI >3mo

A

Oral Abx e.g. co-amoxiclav

172
Q

When should Abx prophylaxis be considered for UTIs?

A

With recurrent UTIs

173
Q

Features of atypical UTI

A

Seriously ill
Poor urine flow
Abdo mass / bladder mass
Elevated creatinine
Septicamiea
Failure to repond to Tx with appropriate Abx within 48hrs
Infection with organism other than E. coli

174
Q

When might transient proteinuria occur?

A

During febrile illness or after exercise

175
Q

CFs acute nephritis?

A

Decreased UO & volume overload
HTN ~–> seizures
Oedema (round eyes)
Haematuria + proteinuria

176
Q

Causes acute nephritis

A

Post infectious (including sterptococcus)
Vasculitis (Henech Schonlein Purpura)
IgA nephropathy

177
Q

Mx Acute nephritis

A

Fluid + electrolyte balance
Diuretics
Monitor for rapid deterioration in renal function

178
Q

Features of West syndrome, and what does EEG show

A

Head nodding, arm jerk,

Hypsarrhythmia

179
Q

What is febrile convulsion and when to treat?

A

Single tonic clonic <20m, high fever, treat if >5m

180
Q

What is status epilepticus defined as?

A

> 30 min tonic-clonic but treat at 5m

181
Q

Mx status epilepticus?

A

Buccal Midazolam –> IV lorazepam –> IV phenytoin –> Rapid sequence intubation

182
Q

When does the newborn physical exam happen and what does it test for?

A

Within 72hrs of birth and + 6 weeks

Full body but mainly hips, heart, eyes, genitalia

183
Q

When is Guthrie’s test carried out?

A

Day 5-8

184
Q

When is school screening?

A

Starting reception and high school

Tests vision, growth, obesity @4yr, and obesity @11yr

185
Q

What are the 2 tests for developmental dysplasia of the hip?

A

Barlow’s (dislocation)

Ortolani’s (relocation)

186
Q

What is spina bifida and what causes it?

A

Failure of neural tube to close in first trimester

Insufficient folic acid
Drugs (valporate, carbamezapine)

187
Q

RFs for DDH

A

Breech presentation
Family Hx
Prematurity

188
Q

6 week key developmental milestone

A

Social smile, eye tracks movement

189
Q

Key developmental milestone 5 months

A

Palmar grasp

190
Q

When do babies walk?

A

9-18 months

191
Q

Cerebral Palsy definition

A

Permanent, non-progressive movement disorder due to a lesion of the developing brain

192
Q

Causes of CP prenatally

A

Cerebral malformation (80%)
Infection (TORCH)
Metabolic

193
Q

Causes of CP perinatally

A

Hypoxia
Intrapartum trauma
Prematurity complications

194
Q

Post natal causes of CP

A

head trauma
stroke
meningitis

195
Q

Presentation of spastic CP

A 
UMN signs
Rigidity
Hypereflexia/tonia
Weakness
Delayed milestones
Poor co-ordination
Persistent primitive reflexes
196
Q

Hemiplegic spastic CP features

A

Unilateral arm > leg spasticity, tiptoe gait and dystonic posture

197
Q

Diplegic spastic CP features

A

Bilateral leg > arm spasticity, knock-knee gait, most common

198
Q

Ataxic CP features

A

Poor coordination
Cerebellar lesions
Ataxic gait
Intention tremor

199
Q

Athetoid (dyskinetic) CP cause and features

A

Basal ganglia lesion due to bilirubin encephalopathy or hypoxic-ischaemic injury

Extrapyramidal signs and fluctuating hyper/hypotonic

200
Q

Associated problems CP

A 
Epilepsy
Audiovisual development problems
Resp problems
Poor growth
Intellectual disability
201
Q

RFs CP

A

Pretem birth
Twins
Maternal infection
Difficult delivery

202
Q

Ix Clinical CP

A

MRI/ CT if ? cause or ongoing conditions e.g. hydrocephalus, ?SDH, ? AVM ? malignancy

203
Q

Mx CP

A

Early MDT involvement

Physio / paeds / SALT / Orthopod /OT / dietitian / community liason

204
Q

CFs Measles

A

Maculopapular rash
Fever
URTI
–> complicated encephalitis

205
Q

CFs Mumps

A

Swollen parotids
Fever
Subfertility in men

206
Q

CFs Rubella

A

Mild fever + rash
Maternal infection
Foetal abnormalities

207
Q

Paeds CPR

A

100-120 bpm
1/3rd chest compression depth

5 rescue breaths -> 15 chest compressions –> 2:15

208
Q

Signs of moderate / severe dehydration

A 
Tachycardia
>2CRT
Weak pulses
Mottling
Cold
Cyanosis
Coma
209
Q

Bolus in hypovolaemia?

A

20ml / kg of 0.9% saline STAT

210
Q

When is a normal bolus amount contra-indicated?

A

In DKA, trauma, neonates

give 10ml/kg instead!

211
Q

What fluid for maintenance?

A

0.9% saline + 5% dextrose + 10mmol KCl

212
Q

Specific features of non-accidental injury

A

Metaphyseal corner fracture (shaking)
Rib fracture
Skull fracture

213
Q

Bruising places in a NAI

A 
ear
cheeks
buttocks
forearms
neck
214
Q

What would make you suspeicious of a NAI?

A

History incompatible with injury / unclear history, delay seeking medical attention
Multiple fractures, retinal haemorrhage, torn frenulum
Injury in a non-ambulatory / totally dependent child

215
Q

Concise features of Septic Arthritis?

A

Red, hot, swollen, tender, monoarthritis, systemic upset.

216
Q

Management of septic arthritis?

A

Urgen Abx, aspirate + washout + orthopod opinion

217
Q

Concise features of Duchenne’s (childhood limp)

A

Proximal weakness,
Boys
Gower’s sign
Resp involvement

218
Q

Who does Perthe’s disease affect and what causes it?

A

4-8 yo boys

Avascular necrosis of femoral head

219
Q

Features of slipped capital femoral epiphysis (childhood limp)

A

obese
adolescent
male
groin pain

220
Q

Complications of prematurity

A

Intraventricular haemorrhage

Retinopathy of prematurity

RDS

NEC

Sepsis

221
Q

What 2 CFs for intraventricular haemorrhage?

A

Seizures

Bulging fontanelle

222
Q

What is a cause of retinopathy of prematurity?

A

Exposure to O2

223
Q

RDS X-ray finding

A

Ground glass XR

224
Q

Respiratory Distress Syndrome Mx

A

Give surfactant
O2
CPAP

225
Q

Feature of NEC

A

Failure to thrive

226
Q

What is preventative of NEC?

A

Breast milk

227
Q

Rx NEC

A

Supportive

And surgery

228
Q

CFs Mastoiditis?

A

Medical emergency –> meningitis, sinus thrombosis,

Ear pushed out / previous otitis media

229
Q

Mx Mastoiditis

A

IV Abx +/- mastoidectomy

230
Q

Parotitis (mumps) CFs

A

Parotid swelling
Fever
Malaise
Scrotal pain

231
Q

Ix mumps (and alternative name)

A

Parotitis

  • Raised amylase
  • IgG/IgM antibodies
232
Q

Mx Mumps and what to watch out for!

A

Fluids/analgesia

Subfertility!

233
Q

What does high IgG + high IgM mean?

A

Recent infection

234
Q

What does high IgG and normal IgM mean?

A

Previous infection or vacciantion

235
Q

What does normal IgG and normal IgM mean?

A

No previous exposure

236
Q

Difference on examination of neck swelling between infected and malignant?

A

Infected = mobile and tender

Malignant = fixed and matted

DONT POKE ANYTHING!

237
Q

Place of bruising in Non accidental injury

A 
Ear
Cheeks
Buttocks
Forearms
Neck
238
Q

What does lithium in pregnancy cause? and what is it?

A

Ebstein’s anomoly

= Displacement of the septal + tricuspid calve, making the RA huge

239
Q

Boot shaped heart on CXR

A

Tetralogy of Fallot

240
Q

Egg on side on CXR

A

ToGA

241
Q

What is rheumatic heart disease?

A

Scarring and fibrosis of valve tissue of the heart –> mitral stenosis

242
Q

What agents cause common cold?

A

Rhinoviruses
RSV

(hence Abx are not effective)

243
Q

RFs for bronchiolitis

A 
Prematurity
Bronchopulmonary dysplasia
CF or congenital heart disease
Maternal smoking
Immunodeficiency
244
Q

What should be given to all children with an acute exacerbation of asthma?

A

Steroid therapy for 3-5 days (e.g. prednisolone)

245
Q

What would blood in the stool make you think of?

A

Intussusception

Gastroenteritis (from either salmonella, or campylobacter)

246
Q

What would vomiting at the end of paroxysmal coughing make you think of?

A

Whooping cough (Pertussis)

247
Q

What would bile-stained vomit make you think of?

A

Instestinal obstruction (esp. intussusception, malrotation and strangulated inguinal hernia)

–> assess for shock + dehydration

248
Q

What causes normal gastro-oesophaegeal reflux?

A

Inappropriate relaxation of lower oesophageal sphincter due to functional immaturity, should resolve by 12m of age

249
Q

Mx simple GOR

A

parental reassurance
feed thickening
upright posture at 30degrees after feeds

250
Q

Mx worse GOR

A

Acid suppression

  1. H2 receptor antagonist (e.g. ranitidine)
  2. PPIs e.g. lanzoprazole
251
Q

If GOR fails to respond to acid repression what should you consider?

A

Cow’s milk protein allergy

252
Q

Presenting age of pyloric steonisis and hallmark feature

A 
2-7wks
Projectile vom (non-bilious)
253
Q

CFs Pyloric stenosis

A

Weight loss, FTT, hungry after feeds

Visible gastric peristalsis, palpable abdo mass on feeding

254
Q

Ix pyloric stenosis

A

Hypkalaemic, hypochloraemic, metabolic alkalosis

USS abdo (diagnostic)

255
Q

Mx pyloric stenosis

A

Rehydration and correct electrolyte imbalance

Surgical : Ramstedt’s pyloromyotomy

256
Q

CFs intussusception

A

Severe paroxysmal abdominal colic pain
Child draws knees up to chest, becomes pale, screaming in pain
Vomiting – may become billious
Blood and mucous in stool – REDCURRENT JELLY
RLQ abdo mass – SAUSAGE SHAPED

257
Q

Ix intussusceptin

A

USS : target sign

Abdo XR: absence of gas in large bowel, distended small bowel

258
Q

CFs malrotation

A

Day 1-3 : failure to pass meconium, abdo pain, tender, BILIOUS vomiting

Later: with peritonitis or ischaemic bowel

259
Q

Mx intussusception

A
  1. Air enema reduction

2. Surgery

260
Q

Causes of intussusception

A

Viral –> increase in peyer’s patches, OR, a lead point e.g. Mickel diverticulum or polyp

261
Q

Causative organism Peptic ulcer

A

Helicobacter pylori

262
Q

Rx Peptic ulcer

A

PPI: omeprazole

If h.pylori suspected: amoxicillin and metronidazole

263
Q

Ix Peptic ulcer

A

C breath test

as H. pylori produces urease

264
Q

Most common cause gastroenteritis in the DEVELOPED world?

A

Viral : rotavirus

265
Q

Bacterial causes of gastroenterisis and what are they suggested by?

A

Suggested by blood in the stools

Campylobacter jejuni
Shigella –> high fever
Salmonella

266
Q

CF gastroenteritis

A

Shock from dehydration in infant

e.g. dry mucous membranes, sunken fontanelle, cold extremities

267
Q

Ix gastroenterisis

A

none usually

stool culture if septic / immunocompromised / recent travel

268
Q

Mx gastroenteritis

A

Fluids (oral if poss)
Abx only if sepsis suspected, or recent travel

ORAL REHYDRATION SOLUTION

269
Q

Difference between clinical dehydration and shock

A

CD (5-10%)

  • irritable, lethargic
  • tachy in HR and RR
  • CRT and pulses normal

Shock (>10%)

  • CRT >2s
  • RR + HR tachy
  • pale or mottled
  • skin turgor and BP decreased
  • decreased LOC
270
Q

Cardinal features of malabsorption

A

Abnormal stools: hard to flush, bad odour
FTT or poor growth
Specific nutrient deficiencies

271
Q

Serology coeliac disease

A

IgA tissue transglutaminase antibodies

Endomysial antibodies

272
Q

Biopsy coeliac disease

A

JEJUNAL
Villous atrophy
Crypt hypertrophy
Increased intraepithelial lymphocytes

273
Q

When do ppl outgrow toddler diarrhoea?

A

Age 5

274
Q

Exacerbating factors toddler diarrhoea?

A

Excessive consumption of fresh fruit juice

275
Q

Mx toddler’s diarrhoea

A

Adequate fat in diet (slows gut transit), and fibre

276
Q

Dx Crohn’s disease

A

Upper GI endoscopy, ilieocolonoscopy & small bowel imaging
Biopsy

277
Q

Histological marker Crohn’s disease

A

Non-caseating epitheloid cell granulomata

278
Q

Dx + confirmation of relapse in Crohn’s?

A

Raised inflamm markers (platelet, ESR, CRP)
Iron deficiency anaemia
Low serum albumin

279
Q

Rx relapse in Crohn’s

A

Immunosuppresants : methotrexate

280
Q

Rx UC

A

FOR MILD: Aminosalicylates e.g. mesalazine

ALSO: topical / systemic steroids (depending on if its confined to the rectum of not)

281
Q

Causes of constipation in babies

A

Hirschsprung disease
Anorectal abnormalities
Hypothyroidism
Hypercalcaemia

282
Q

Causes of constipation in children

A

Issues w toilet training, unpleasant toilet or stress

Precipitated by dehydration or painful anal fissure

283
Q

Treatment pathway for constipation

A
  1. Balanced diet and sufficient fluids
    Sit on toilet after meal times –> utilise the gastrocolic reflex
  2. A stool softner e.g. movicol
  3. An osmotic laxative e.g. lactulose
  4. A stimulant laxative e.g. senna
  5. Enema or manual evacuation (under anaesthetic)
284
Q

What syndrome is Hirshsprung’s disease associated with, and gender?

A

Trisomy 21

Boys &raquo_space; girls

285
Q

What is Hirshsprung’s disease?

A

Large bowel obstruction
Absence of ganglionic cells from myenteric plexus of large bowel
Results in a narrow, contracted segment of bowel

286
Q

Clinical features Hirshsprung’s disease

A

Abdo distension
Later bile stained vomit
Can lead to entercolitis from C Diff infection

287
Q

Presentation Hirshsprung’s disease

A

Presentation – failure to pass meconium within 48hrs of life

288
Q

Ix Hirshsprung’s disease

A

Rectal examination
- Narrow segment. Withdrawl causes flow of liquid stool and flatus

Suction rectal biopsy (diagnostic)

289
Q

Mx Hirshsprung’s disease

A

Enema’s

Surgical resection of affected colon (3-stage procedure)

290
Q

Overal all risk of a subsequent febrile seizure

A

1 in 3

291
Q

Which febrile seizure increases chance of epilepsy?

A

Complex febrile seizure

they last 15-30mins and are focal seizures

292
Q

2 types of paroxysmal disorders : “funny turns”

A
  1. breath-holding episodes (precipitated by anger –> blue –> limp)
  2. reflex anoxic seizures (precipitated by pain –> pale –> sometimes brief seizure)
    • cause: cardiac asystole from vagal inhibition
293
Q

Px Duchenne Muscular Dystrophy

A

Waddling gait and / or language delay.

Have to mount stairs one-by-one

294
Q

Prognosis Duchenne’s

A

late 20s

Due to resp failure or cardiomyopathy

295
Q

Mx Duchenne’s

A 
Exercise
Keep good sitting posture
Splints
Corticosteroids to maintain walking
CPAP at night due to weakend muscles
296
Q

Inheritance in Duchenne’s

A

X-linked recessive disorder

297
Q

What is osteomyelitis?

A

Infection of the metaphysis (growth plate) of long bones

298
Q

Pathogen in osteomyelitis AND septic arthritis?

A

Staph Aureus

299
Q

Presentation osteomyelitis

A

Painful immobile limb

+ Acute febrile illness

300
Q

Dx osteomyelitis

A

+ve blood cultures

increased WBC count

301
Q

How can transient synovitis be differentiated from septic arthritis?

A

SA is:

  • more acute
  • severe pain @ rest
  • worse on any movement attempt
302
Q

How to differentiate between septic arthritis and osteomyelitis

A

SA: pain over joint
OM: pain over bone

303
Q

Ix septic arthritis

A

Increased WCC and acute phase reactants
XR: widening of joint space + soft tissue swelling
Joint aspiration under USS for organisms & culture

304
Q

Rx septic arthritis

A
  1. Abx (after culture): flucloxacillin

2. Washing out/ surgical drain

305
Q

Name 4 ptimitive reflexes

A

Stepping
Moro
Grasp
Rooting

306
Q

When should primitive reflexes disappear by?

A

6 months, if persist –> pathology

307
Q

types of CP

A

Spastic
Dyskinetic
Ataxic

308
Q

What is the hallmark of spastic CP?

A

Dynamic catch

(tone is velocity dependent, the faster the muscle is stretched, the greater resistence it will have)

Clasp-knife

309
Q

4 Features Autistic Spectrum disorders

A

Impaired social interaction
Speech and language disorder
Imposition of routines with ritualistic and repetitive behaviour
Co-morbidities

310
Q

Rx Autistic Spectrum disorders

A

Applied behavioural analysis (ABA)

311
Q

Which type of hearing loss presents at brith and is usually irreversible?

A

Sensorineural hearing loss

312
Q

Causes of conductive hearing loss?

A

OME
Downs
Wax

313
Q

Mx conductive hearing loss

A

Conservative
Amplification
Grommets

314
Q

Klinefelter syndrome genetic

A

47, XXY

315
Q

Most common presentation of klinefelter syndrome

A

infertility (puberty may seem normal)

316
Q

Features of klinefelter syndrome

A

Tall stature
hypogonadism w small testes
gynaecomastia in adolescene

317
Q

What counts as low birth weight?

A

<2500g

Smoking reduces BW

318
Q

What is a pre-term baby?

A

gestation <37weeks

319
Q

What is a post-term baba

A

Gestation >/= 42 weeks

320
Q

What does maternal diabetes make a newborn more prone to?

A

Through macrosomnia:
hypoglycaemia
polycythaemia (raised haematocrit)

321
Q

What does apgar score do and when is it done?

A

Used to describe baby’s condition at 1 and 5 mins after delivery

score out of 10

322
Q

What are the elements of the apgar score?

A
  1. HR
  2. Resp effort
  3. Muscle tone
  4. Reflex irritability
  5. Color
323
Q

Role of vitamin K to neonates?

A

Given IM to all neonates to prevent haemorrhagic disease ofthe newborn

324
Q

Causes of hypoxic-ischaemic encephalopathy

A
  1. failure of gas exchange across the placenta: excessive contractions, placental abruption
  2. interruption of umbilical blood flow: cord compression
  3. inadequate maternal placental perfusion: maternal hypo/hyper tension, often with IUGR
  4. failure of cardioresp adaptation at birth: failure to breath
325
Q

Respiratory distress syndrome, what is it?

A

Deficiency of surfactant, which lowers surface tension –> widespread alveolar collapse + inadequate gas exchange

v. common <28 weeks

326
Q

Rx antenatal to prevent RDS

A

Glucocorticoids

327
Q

CXR of RDS

A

“ground glass” appearance of lungs

328
Q

Complications RDS

A

Pulmonary interstitial emphysema
Pneumothorax

(prevent by ventilating at lowest pressures you can get away with)

329
Q

Rx Pre-term brain injury

A

LP
Ventricular tap
Ventricularperitoneal shunt

330
Q

What happens in retinopathy of prematurity?

A

Babies used to hypoxic environment, when faced with increasd O2, vascular proliferation –> retinal detachment

331
Q

Rx retinopathy of prematurity

A

Laser therapy decrases visual impairment

332
Q

Acute manifestation kernicterus

A

Lethargy

poor feeding

333
Q

What type of CP might survirors of kernicterus develop?

A

Choreoathetoid CP

334
Q

Haeomlytic diseases that cause pathological jaundice

A

Rhesus haemolytic disease
ABO incompatability
GP6D deficiency

335
Q

What must you worry about in jaundice >2wks of age, and how to recognise

A

Biliary atresia

  • hard liver, swollen abdo, grey stools, dark urine
  • Kasai procedure

Also: congenital hypothyroidism

336
Q

Ix neonatal jaundice (split into 3 categories)

A

Haemoglobin: FBC
Biochem: Serum B
MOs: blood film

337
Q

Mx jaundice

A

Phototherapy

Exchange transfusion

338
Q

When does menarhce occur in girls?

A

2.5yrs after start of puberty

Breast development is age 8.5-12.5

339
Q

Menstruation: normal cycle length, blood loss length and volume

A

21-45 days
3-7 days
<80ml

Ix if clots or using >6 pads per day: ? von Willebrand disease?

340
Q

Ix abnormally early or late puberty

A

Wrist and band X-ray for bone age

USS pelvic in females: uteine size and thickness

341
Q

How to calculate genetic target heigt centile + range

A

(Mean of mum and dad’s height)

  • 7cm for a girl

+ 7cm for a boy

342
Q

Causes of short stature

A 
Familial
IUGR + extreme prematurity 
Endocrine e.g. hypothy or GH deficiency
Chronic illness e.g. Crohn's, coeliac (FBC)
Psychosocial deprvation
343
Q

Rx short stature

A

SC biosynthetic GH

344
Q

Causes tall stature

A

familial
obestity
secondary e.g. hyperthyroidism
Syndromes e.g. marfans, Klinefelters

345
Q

Rx tall stature

A

testosterone or oestrogen therapy

346
Q

Definition premature sexual development

A

Development of secondary sexual characteristics before 8yrs in female, and before 9 yrs in male

Its called precocious puberty when accompanied by a growth spurt

347
Q

2 types of precicious puberty

A
  1. Gonadotropin-dependent: premature activation of the HPG axis
    - e.g. familial, CNS abnormalities, hypothy
  2. Gonadotropin-independent (LH and FSH low): from excess sex steroids (exogenous sex steroids)
    e. g. CAH, tumors,
348
Q

define delayed puberty

A

Absence of pubertal development by age 14yrs in female, and age 15yrs in male

349
Q

Causes delayed puberty

A
  1. constitutional delay
  2. low gonadotropin secretion e.g. systemic disase, anorexia, too much exercise
  3. high gonadotropin secretion e.g. klinefelters, turners, aquired gonadal damange
350
Q

What gene determines sex?

A

SRY gene on Y chromosome

351
Q

What happens in congenital adrenal hyperplasia?

A

deficiency of enzyme 21-hydroxylase

cant produce aldosterone –> salt loss

352
Q

Female presentation CAH

A

virilisation of external genitalia

353
Q

Male presentation CAH

A

salt losing adrenal crisis at 1-3 weeks of age

vomiting + weightloss, floppy

354
Q

Dx CAH

A

VERY raised 17alpha-hydroxypogesterone in blood

salt losers: met aci, low na

355
Q

Mx CAH

A 
lifelong glucocorticoids (to supress ACTH levels)
mineralcortioids if there is salt loss
356
Q

Rx salt-losing adrenal crisis

A

IV hydrocortisone, saline + glucose IV

357
Q

Causes of failure to thrive

A
  1. inadequte intake (either inorganic/env, or organic)
  2. inadequate retention
  3. malab
  4. increased requirements
  5. failure to utilise nutrients
358
Q

sources of vitamin d in food

A

fish liver oil
fatty fish
egg yolk

359
Q

What is osteomalacia?

A

failure of mature bone to mineralise

360
Q

Causes of rickets:

A
  1. nutritional (primary) rickets: living in N with dark skin, diets low in calcium, phosphorus and vit D, strict vegan diets
  2. intestinal malab
361
Q

Dx rickets

A

Serum calcium : low / normal
Phosphorus low
25-hydydroxyvit D low
PHT high

X-ray: cupping + fraying of metaphysis and wideneed epiphyseal plate

362
Q

Rx rickets

A

Advice re balanced diet
Correction of RFs
Daily vit D3 - cholecalciferol

363
Q

What is obesity?

A

> 98th centril of UK 1990 reference chart for age + sex

What is overweight? >91st centrile

364
Q

Epstein-Barr Virus aka Glandualr fever CFs

A

fever
malaise
tonsilopharyngitis
lymphadenopathy

365
Q

Dx EBV

A

Positive monospot test

Large T cells on blood film

366
Q

What can parvovirus B19 cause in the fetus?

A

Hydrops

367
Q

Causeative organism hand,foot and mouth?

A

Coxsackie virus A16

368
Q

What causes chickenpox?

A

Primary varicella zoster infection

369
Q

Cfs chicken pox

A

fever, itchy , vesicular rash that is Px for up to 7 days

370
Q

Exposure chickenc pox

A

Resp droplets,

very contagious in viral shedding stage

371
Q

Complications chicken pox

A
  1. secondary bacterial infection

2. encephalitis

372
Q

Rx chicken pox (immunocompromised or adolescent)

A
  1. if immunocompromised, acyclovir initially

2. if adult / adolescent: valaciclovir

373
Q

CFs measles

A 
Koplick spots (on buccal mucosa)
Maculopapular rash (flat red area on skin covered with small bumps)

fever, cough, runny nose

374
Q

Reduction of vertical transmission of HIV

A

Avoid Br feeding
Use of antiretroviral drugs
Elective C-sec to avoid contact with birth canal

375
Q

Progression of rash in chicken pox

A

Papules vesicles pustules crusts

376
Q

Ix food allergy and intollerance

A

RAST test (radioallergosorbent test) or skin prick test

377
Q

Rx for anaphylactic reactions

A

IM adrenaline

378
Q

Cause of lactose intolerance

A

Post-viral gastroenteritis lactase deficiency e.g. rotavirus

379
Q

Rx lactose inloterance

A

lactose-free formula milk

380
Q

What do the CFs of cows milk protein allergy depend on?

A

Where the location of the inflammation is

381
Q

Rx cows milk protein allergy

A

Maternal exclusion of cows milk if br fed

382
Q

Rx allergic rhinitis

A

antihistamines e.g. loratidine

topical nasal corticosteroids e.g. comoglycate eye drops

383
Q

Rx inguinal hernia

A

‘Irreducible’ can be reduced after opiod analgesia + sustained gentle compression

384
Q

Classification of undescended testis

A

Retractible
Palpable
Impalpable

385
Q

Ix for undescended testes?

A

USS
Laparoscopy

(hormonal)

386
Q

Indications for surgery in undescended testes?

A

Feriity: they need to be below body temp
Malignancy
Cosmetic: to insert prosthetic if absent

387
Q

When must testicular torsion be relived by for testicular viabilty?

A

6-12 hrs of onset of symptoms

388
Q

Classical triad of T1DM

A

polydipsia
polyuria
weight loss

389
Q

CFs DKA

A 
acetone on breath
vom
dehydration
abdo pain
hypervent due to acidosis (kussmaul breathing)
hypovolaemic shock
drowniess, coma and death
390
Q

What is diagnositc of DM?

A

Random BM >11.1 mmol/L
PLUS glycosuria + ketonuria

Fasting >7mmol or raised HbA1c are helpful

391
Q

Initial Mx T1DM

A
  1. Educational program
  2. Insulin
    • rapid acting (novorapid)
    • short acting (actrapid)
      - intermediate acting
      - very long acting
392
Q

Injection sites in DM, and why rotate?

A

SC tissue : upper arm, front and side of thight, buttocks, abdo

to prevent lipohypertrophy

393
Q

How often is HbA1c checked and what does it show?

A

at least 3 times per year
shows the average sugars prev 6-12 weeks
aim for 4-6mmol

394
Q

Symptoms of a hypo

A

<2.6mol

hunger, tum ache, sweatiness, faint dizzy

can –> seizures + death

395
Q

Rx hypoglycamia

A

lucozade tablets / glucogel

396
Q

Ix DKA

A 
BM > 11.1
U&amp;Es
Creatinine (dehydration)
severe metabolic acidosis
urine glucose + ketones
cardiac monitor for T wave changes of hypokalaemia ***
397
Q

Mx DKA

A 
ABC
fluids
insulin (not bolus!!)
K + Na
dextrose after a while
398
Q

Cause hypoglycaemia

A

Excess insulin
B-cell tumor
drug induced e.g. sulphonylurea

if without hyperinsulinaemia: liver disease

399
Q

Cause congenital hypothyroidism

A

maldescent of the thyroid

400
Q

CF cong hypothyroidism

A

congenital: FTT, feeding problems, prolonged jaundice, constipated, large tongue
acquired: short, dry skin, Learning disability, obesity

401
Q

When is Rx for nocturnal enuresis considered, and the Rx pathway?

A

> 6yrs old

  1. explanation
  2. star charts
  3. enuresis alarm
  4. desmopressin (synthetic analogue of ADH)
402
Q

Atopic eczema causes of exacerbation

A

bacterial infection
ingestion of allergen
humidity
psych stress

403
Q

Mx atopic eczema pathway

A
  1. avoid irritants
  2. emotioents e.g. aqueous cream
  3. topical corticosteroids (SE: thinning of skin)
  4. Occlusive bandages

EXTRA
5. Abx for infected eczema
6 Dietary eliiation of cows milk, egg, soya
7. Psychosocail support

*Phase 3a Julia (8 decks)

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