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Paeds > Gastro and Urinary > Flashcards

Gastro and Urinary Flashcards

1
Q

What is enuresis defined as

A

Involuntary discharge of urine by day or night in a child over 5 in the absense of congenital or acquired defects of the NS or urinary tract

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2
Q

How is nocturnal enuresis categorised

A

Primary- never achieved continence
Secondary- child had been dry for at least 6 months

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3
Q

Management of enuresis

A

Rule out other causes
General adive- fluid intake, empty bladder before bed and during day
Reward system- eg star chart for going toilet before bed and not for a dry night
Then- Enuresis alarm
Then- desmopressin

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4
Q

When would use desmopressin for enuresis

A

Short term control needed- sleepoves
Enuresis alarm not effective or acceptable

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5
Q

Examination findings of testicular torsion

A

Swollen testicle
Absent cremasteric reflex
Elevation of testicle worsens pain

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6
Q

What causes threadworms

A

Enterobius vermicularis
Infestation occurs after swallowing eggs in the environment

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7
Q

How can threadworms be investigated

A

Could put piece of tape over anus and then do MCS

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8
Q

Management of threadworms

A

Under 6 months- hygiene measures for 6 weeks (same if pregnant or breastfeeding)
6 months- 2 years- piperazine single dose
Over 2 years- Single does of mebendazole with hygiene measures for 2 weeks if over 2 years
Consider treating whole family too
If infection persists over 2 weeks/6 weeks treat again

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9
Q

What is hirschprungs disease

A

Presence of aganglionic segement of bowel from developmental failure of parasympathetic Auerbach (myenteric) and meissner (submucosal) plexuses

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10
Q

Presentation of hirschprungs disease

A

Failure to pass meconium in first 24 hours
Bilious vomiting
Abdo distension
Constipation mixed with overflow diarrhoea

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11
Q

Complications of hirschprungs disease

A

Enterocolitis
Perofration
Meconium plug syndrome

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12
Q

Initial investigation for hirschprungs and diagnostic

A

AXR if obstruction
Full thickness rectal biopsy

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13
Q

Treatment for hirschprungs

A

Bowel irrigation initially- can be barium enema
Transanal endorectal pull through

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14
Q

Risk factors for hirshcprung disease

A

Trisomy 21
Male
MEN2A

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15
Q

Risk factors for GORD

A

Preterm delivery
Neuro disorders

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16
Q

Presentation of GORD

A

Vomiting of feeds
Develops before 8 weeks typically
Alongside
- arching of back
- irrittable
- crying

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17
Q

When should arrange same day referral for GORD

A

Haematemesis
Melaena
Dysphagia

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18
Q

When should arrange a specialist assessment by paediatrician GORD

A

Uncertain diagnosis
Growth issues
Unexplained distress in those with communication difficulty
Not responding to treatment
Avoiding food
Unexplained IDA
No improvement in GORD after a year
Sandifers syndrome suspected
Recurrent aspiration pneumonia
Upper airway erosion
Dental erosion in child with neurodisability
Recurrent otitis media (more than 3 episodes in 6 months)

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19
Q

Management of GORD in child breastfeeding

A
  1. Breastfeeding assessment and advice
  2. 1-2 week trial of alginate therapy- if symptoms improve after 2 weeks continue the therapy. Stop at regular intervals to see if symptoms have improved
    If have not then medical treatment
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20
Q

Mangement of GORD in formula fed

A
  1. Reduce volume of milk if excessive (150ml a day per kg)
  2. Offer 1-2 weeks of smaller more frequent unless they already are small and frequent
  3. 1-2 weeks of feed thickeners
  4. Alginate therapy
  5. Medical management
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21
Q

Medical management of GORD

A

4 week suspension of omeprazole
If doesnt work refer for possible endoscopy and potential metoclopramide treatment

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22
Q

Complications of GORD

A

Distress
FTT
Aspiration
Frequent otitis media
Dental erosion in older children

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23
Q

When does pyloric stenosis typically present

A

2nd-4th week of life

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24
Q

What causes pyloric stenosis

A

Hypertrophy of smooth circular muscles of pylorus

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25
Q

Risk factors for pyloric stenosis

A

Male
Positive family history
First born child
Turners syndrome

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26
Q

Examination finding of pyloric stenosis

A

Palpable olive epigastric mass
Dehydration
Visible peristalsis

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27
Q

Blood gas finding of pyloric stenosis

A

Hypochloraemic, hypokalaemic alkalosis but can become dehydrated lactic acidosis

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28
Q

Presentation of pyloric stenosis

A

Projectile vomiting 30 mins after feed
Constipation and dehydration

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29
Q

How is pyloric stenosis diagnosed

A

Test feed where look for visible peristalsis
US- target lesion over 3mm

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30
Q

Hos is pyloric stenosis managed

A

Treat fluid and electrolyte loss
NG tube
Ramstedt pyloromyotomy

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31
Q

Chronic diarrhoea differentials in a child

A

Cows milk intolerance
Toddler diarrhoea
Coeliac disease
Lactose intolerance

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32
Q

How does lactose intolerance present

A

Abdo pain and bloating linked to dairy eating
Diarrhoea

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33
Q

How can an upper UTI be diagnosed in a child

A

2 ways
- fever over 38 and bacteriuria
- fever under 38, bacteriurua and loin pain/tenderness

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34
Q

What to do if upper UTI suggested in child

A

Depending on severity send urine for MCS and if severe consider referral

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35
Q

What do if UTI suspected in under 3 months

A

Refer to paediatrics with parenteral abx

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36
Q

What do if UTI suspected in child over 3 months

A

Perform dipstick

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37
Q

What do if in child leukocyte and nitrite positive

A

Start treatment
Send a culture if recurrent UTIs, suspect upper UTI, no response in 48 hours to treatment

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38
Q

What to do in child if leukocyte pos and nitrite negative

A

Under 3 start abx and send for culture- reassess after
Over 3 only start abx if really suspect UTI

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39
Q

What to do in child if leukocyte neg and nitrite pos

A

Start abx and send for culture

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40
Q

Which 2 abx are available for upper UTI

A

Co-amoxiclav or cefalexin depending on sensitivity
Referral depends on severity

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41
Q

Children older than 3 months with UTI treatment

A

1st line- trimethoprim (if there is low risk of resistance), or nitrofurantoin (if eGFR ≥ 45ml/minute)
2nd line- nitrofurantoin (if eGFR ≥ 45ml/minute) if it has not been used as a first-line option, amoxicillin (only if culture results available and susceptible), or cefalexin.
Potentially do an US if indicated

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42
Q

When prescribing nitrodurantoin to over 3 months what is important criteria

A

eGFR over 45

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43
Q

When is an US indicated in UTI DURING the infection

A

In all children
- poor urinary flow
- abdo or bladder mass
- sepsis
- raised creatinine
- does not respond within 48 hours
- non-ecoli
If under 6 months with recurrent UTI

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44
Q

When is an US indicated in UTI 6 weeks after the infection

A

Children aged 6 months or older with recurrent UTI
Children under 6 months with first time UTI that responds to treatment

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45
Q

When is DMSA and MCUG scan indicated 6 months after UTI

A

If under 3 years and atypical or recurrent UTI
If over 3 years and recurrent UTI

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46
Q

What defines recurrent UTI

A

2 upper UTI episodes
1 upper and 1 lower UTI episode
3 lower episodes

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47
Q

What is done if somone has recurrent UTIs

A

Prophylactic abx which depends on local resistance
First line- trimethoprin and nitro
Second line- cefalexin and amoxicillin
If under 6 months do US during the infection
If over 6 months do in 6 weeks
Do a DMSA scan within 6 months

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48
Q

Presentation of wilms tumour

A

Abdo mass
Painless haematuria
Flank pain
Anorexia and fever

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49
Q

Where does wilm tumour most commonly metastasise

A

The lung

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50
Q

What do with unexplained enlarged abdo mass in achild

A

Refer for paediatric review in 48 hours

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51
Q

How are nephroblastomas imaged

A

USS intitally then CT NOT Biospy

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52
Q

Management of wilms tumour

A

Nephrectomy and chemo
Radiotherapy if advanced

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53
Q

Associations of Wilms tumour

A

Beckwith-Wiedemann syndrome
WAGR
Loss of function mutation in the WT1 gene chromosome 11

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54
Q

What is included in WAGR syndrome

A

Wilms tumour, Aniridia, Genitourinary malformations, mental Retardation

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55
Q

Management of undescended testes

A

Unilateral
- Patient should be referred from around 3 months seeing a urological surgeon by 6 months of age
- if bilateral reveiwed within 24 hours as needs urgent genetic or endocrine investigation

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56
Q

What is hypospadias

A

Congenital abnormality of the urethral opening- appears with ventral urethral meatus

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57
Q

How can hypospadias be identified

A

Newborn check
Abnormal urine flow noticed by parent

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58
Q

Examination findings of hypospadias

A

Ventral urethral meatus
Hooded prepuce (where foreskin wide open)
Ventral curvature of the penis

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59
Q

Management of hypospadias

A

Refer to specialists
Operation at 12 months
Can’t be circumcised
If very distal may not need operation

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60
Q

Associated conditions of hypospadias

A

Inguinal hernia
Cryptochordism

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61
Q

How does meckels diverticulum present

A

Rectal bleeidng
Abdo pain like appendicitisi

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62
Q

What determines the initial investigation for meckels diverticulum

A

If haem stable technietium99
If not and needed transfusion- arteriography

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63
Q

Managment of meckels diverticulum

A

Surgical- wedge excision or resection

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64
Q

What are differences between gastrochisis and ampholacele

A

Gastrochisis is lateral to umbilicus whereas ampholacele is through umbilicus
Ampholacele has a thin sac whereas gastrochisis is just the organs
Gastrochisis is vaginal delivery versus C section in ampholacele to preserve the sac
Gastrochisis requires surgery within 4 hours but ampholacele surgery done in stages
Gastrochisis associated with smoking and low scoioeconomic status whereas ampholacele associated with downs, kidney and cardiac abnormalities

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65
Q

Features indicative of idiopathic constipation

A

Meconium passed within 48 hours of birth (in a full-term baby).
Onset of constipation at least a few weeks after birth.
Presence of precipitating factors:
- Dietary factors (for example changes to infant formula or weaning, poor diet, or insufficient fluid intake).
- Acute illness, such as infection.
- Anal fissure.
- Use of drug treatments such as sedating antihistamines or opiates.
- Timing of potty or toilet training.
- Psychosocial factors such as difficulty accessing a toilet, moving house, starting nursery or school, other major change in family circumstances, and fears and phobias

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66
Q

What to do if amber and red signs in constipation history

A

Red- refer immediately to specialist and do not treat immediately
Amber- refer for specialist help (2 weeks) and can treat in meantime

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67
Q

Red flag features for constipation

A

Symptoms of constipation appearing from birth or during the first few weeks of life — may indicate Hirschsprung’s disease
Delay in passing meconium for more than 48 hours after birth, in a full-term baby
Abdominal distention with vomiting
Family history of Hirschsprung’s disease
Ribbon stool pattern
Leg weakness or motor delay
Examination may reveal unexplained lower limb deformity or abnormal neuromuscular signs, including abnormal reflexes.
Abnormal appearance of the anus
Abnormalities in the lumbosacral and gluteal regions

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68
Q

Amber features for constipation

A

Evidence of faltering growth, developmental delay, or concerns about wellbeing, which may indicate a systemic condition - coeliac disease, hypothyroidism, cystic fibrosis, and electrolyte disturbance
Constipation triggered by the introduction of cows’ milk
Concern of possible child maltreatment — follow local child safeguarding procedures.

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69
Q

What does ribbon stools suggest

A

Anal stenosis- typically in infants

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70
Q

Umbilical hernias in children

A

Very normal and will often resolve by 3 years
Management is obervation

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71
Q

Features which suggest sexual abuse in a child

A

pregnancy
sexually transmitted infections, recurrent UTIs
sexually precocious behaviour
anal fissure, bruising
reflex anal dilatation
enuresis and encopresis
behavioural problems, self-harm
recurrent symptoms e.g. headaches, abdominal pain

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72
Q

Who is most likely person to sexually abuse a child

A

Father
Unrelated man
Older brother

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73
Q

What is position of appendix if obturator sign present

A

Pelvic

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74
Q

Most common position of appendix

A

Retrocaecal

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75
Q

How does oesophageal atresia present

A

Drooling
Gags and chokes when feeding
Cough
Cyanotic

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76
Q

Investigations for oesophageal atresia/TOF

A

NG tube aspiration with CXR
Gastrogaffin swallow is gold standard

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77
Q

Complications of oesophageal atresia and TOF

A

Aspiration of food
Acid in the lungs causing CLD

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78
Q

What is faecal impaction and how does it present

A

When there is a large faecal mass in the rectum
Presents with
- severe constipation symptoms
- overflow sx like soiling
- large mass on palpation

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79
Q

Management of faecal disimpaction

A

Macrogol and review after 1 week
If after 2 weeks does not work use stimulant laxative like Senna
If does not work refer to specialist
If not tolerant of macrogol use senna and if the stools are hard add lactulose or docusate

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80
Q

Management of constipation

A

Macrogol (drug depends on age) If over 12 Mavicol, if under mavicol paediatric
If not tolerated use senna and add lactulose if not tolerated
If does not improve use Senna however if get diarrhoea reduce dose

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81
Q

When to refer gastroenteritis

A

Bilious vomiting/difficult to control vomiting
Blood in stool
Severe dehydration/shock
HUS

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82
Q

How is giardia treated

A

Tinidazole

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83
Q

When can go back to school with HUS

A

2 consecutive negative samples 24 hours apaprt

84
Q

How are viral gastroenteritises diagnosed

A

Stool electron microscopy

85
Q

Managment of primary enuresis with daytime symptoms

A

Refer all children with daytime symptoms to enuresis clinic

86
Q

Management of secondary bedwetting

A

Urinalysis and constipation checks
If no cause found refer

87
Q

How can volvulus present

A

Bilious vomiting and severe pain/irritability
Blood in stool is late stage of ischaemia

88
Q

How does autosomal recessive PCKD present

A

Presents perinatally and most of time will be dead by 12 months
Renal cysts with subsequent renal and hepatic fibrosis
Renal failure too

89
Q

Complications of autosomal recessive PCKD

A

Oligohydramnios leading to pulmonary hypoplasia

90
Q

Treatment for hyperconjugated hyperbilirubinaemia

A

Ursodeoxycolic acid

91
Q

Causes of hyperconjugated bilirubinaemia

A

Biliary atresia
Choledochal cysts

92
Q

Risks of gastrochisis

A

Dehydration and shock from fluid loss
Malrotation

93
Q

Management of gastrochisis

A

Place cling film over bowels
Surgery within a few hours except for if signs of impaired bowel perfusion

94
Q

Presentation of enterocolitis in hirschprungs

A

Abdo pain
Blood in stool
Fever

95
Q

First line for intussusception

A

Air insufflation then surgical intervention

96
Q

Complications of minimal change disease

A

Recurrent infections
Increased thrombosis risk
Hypercholesterolaemia

97
Q

What causes bloating and diarrhoea post gastroenteritis

A

Is normal to get a post infectious IBS when normal diet reintroduced

98
Q

Infections that can precede mesenteric adenitis

A

URTI
Gastroenteritis most commonly Yersinia

99
Q

What can cause recurrent intussusception

A

Meckels diverticulum

100
Q

What is most common cause of acute scrotum in children

A

Hydatid torsion

101
Q

What is hydatid torsion

A

Twisting of testicular appendage which is a remnant of the muellerian tube

102
Q

Presentation of hydatid torsion

A

Pain over a few days (not acute)
Swelling
Cremasteric reflex present
Blue dot sign
Tender at top of testicle not whole testicle

103
Q

Presentation of epididymitis

A

Dysuria or discharge
Pain and swelling of the testicle
Prehns and cremasteric positive

104
Q

How to investigate an acute scrotum

A

Doppler is best way to assess testicular blood flow
Surgical exploration is necessary if cant exclude torsion

105
Q

Complications of undescended testicles

A

Testicular torsion
Infertility
Testicular cancer

106
Q

What are the types of TOF

A

Type A- no connection between proximal and distal oesophagus
Type B- fistula between proximal oesophagus to trachea
Type C- fistula between distal oesophagus to trachea
Type D- fistula between proximal and distal oesophagus to trachea
Type E- normal oesophagus connection but fistula to trachea too

107
Q

First line and definitive management of oesophageal atresia and TOF

A

Repogle tube to drain the saliva
Surgical management

108
Q

What is blue dot sign

A

Blue dot on testicle caused by hydatid torsion typically

109
Q

Triad for nephrotic syndrome

A

Oedema- normally periorbital or sacral
Hypoalbuminaemia- >25g/L
Proteinuria- 3g/24 hour or PCR over 15/mg/mmol

110
Q

Complications of nephrotic syndrome

A

Hyperlipidaemia
Thrombosis
Pneumooccocal risk
Hypovolaemia

111
Q

Treatment of hypovolaemia in nephrotic syndrome

A

IV albumin

112
Q

Most common cause of nephrotic syndrome in a child

A

Minimal change disease

113
Q

Treatment of minimal change disease

A

Oral pred and then reduce the dose over time

114
Q

Causes of nephrotic syndrome in children

A

Minimal change disease
Focal segemental glomerulosclerosis
Mesangiocapillary glomerulonephritis
Membranous nephropathy

115
Q

Steroid resistant causes of nephrotic syndrome

A

Focal segmental glomerulosclerosis- most common
Mesangiocapillary glomerulonephritis
Membranous nephropathy

116
Q

Low complement levels
Haematuria
Renal function declining over many years
Older children

A

Mesangiocapillary glomerluonpehritis

117
Q

What do if fail to cure minimal change disease

A

Biopsy

118
Q

Biopsy finding of minimal change disease

A

Diffuse loss of podocytes

119
Q

Causes of membranous nephropathy

A

Hep B

120
Q

Benign causes of proteinuria

A

Transient- febrile illness or after exercise
Orthostatic- common if upright all of the day

121
Q

Triad for nephritic syndrome

A

Hypertension
Haematuria
Oedema
(with oligouria)

122
Q

Difference between red and brown coloured urine

A

Red- lower tract bleed
Brown- glomerular pathology as broken down into casts

123
Q

Problems of glomerulonephritis

A

Loss of barrier function- blood or protein lost
Loss of filtering capacity- accumulation of toxins

124
Q

Causes of glomerulonephritis

A

IgA nephropathy- most common
HSP
Anti-glomerular basement membrane (Goodpastures)
Post streptococcal

125
Q

Difference between IgA nephropathy, HSP and post streptococcal

A

IgA and HSP within a few days
Post streptococcal within a month
HSP is in essence a systemic version of IgA nephropathy

126
Q

What can precede intussusception

A

Coryzal illness
Tummy bug

127
Q

What are associated with malrotation

A

Congenital diaphragmatic hernia
Exomphalos

128
Q

Investigation for anti GBM

A

IgG type IV lung and kidney

129
Q

Haemoptysis and haematuria cause of AKI

A

Anti-GBM

130
Q

Hearing and vision loss with haematuria

A

Alports syndrome

131
Q

How does rhabdomyolysis present

A

Dark urine
Muscle pain
Signs of hyperkalaemia

132
Q

Blood findings of rhabdomyolysis

A

Hyperkalaemia
Increased CK

133
Q

What is complication of a renal scar

A

HTN- may need monitoring regularly

134
Q

How is severeity of UC classified

A

Either true love and witts or paediatric ulcerative colitis activity index
Categorised into mild, moderate and severe

135
Q

Management of active UC

A

Mild to moderate
- topical aminosalicylates for 4 weeks
- if dont work use oral
- can use steroids too if ineffective (topical or oral)

Moderate to severe
- infliximab, adalimumab

136
Q

How to maintain remission in UC

A

Oral aminosalicylate
Consider oral azathioprine or oral mercatopurine

137
Q

What is monitored in children with UC and crohns

A

Vitamins and anaemia
Growth
Bone density
Sigmoidoscopy to screen for adenocarcinoma in UC

138
Q

Managment of active crohns

A

Induction of remission
- oral glucocorticoid
If more than 1 exacerbation a year or can increase glucorticoid dose, add azathioprine or mercatopurine
If these are contraindicated add methotrexate

139
Q

Maintaing remission in crohns

A

Azathioprine or mercatopurine
If fails/contraindicated then use methotrexate

140
Q

Complications of UC

A

Toxic megacolon
Erythema nodosum
PSC
Haemorrhage
Cancer

141
Q

Differences between UC and crohns

A

Crohns affects all layers, UC mucosa and submucosa
Crohns affects mouth to anus, UC distal to proximal spread

142
Q

When refer with bedwetting

A

If have daytime symptoms then refer
If secondary bedwetting after have ruled out UTI, DM and anxiety
Primary if 2 rounds of treatment have not worked

143
Q

What could cause secondary bedwetting

A

UTI
DM
Electrolyte abnormalities- hypokalaemia, hypercalcaemia
Anxiety

144
Q

What is management of inguinal hernias in children

A

Refer to paeds surgery ASAP

145
Q

How does intussuception present

A

Bilious vomiting
Screaming and crying
Bringing knees up
Red stool a late presentation

146
Q

Guidelines for phimosis

A

If present under 2 is physiological- only refer when older than 2 years
Do not forcibly retract as can cause scarring

147
Q

Management of ballooning of foreskin during micurition in under 2

A

Can leave alone until 2 years old then avoid

148
Q

Where is most common palpated site of intussuception

A

RUQ

149
Q

MOst common site of intussusception

A

Ileo-caecal

150
Q

investigation for intussusception

A

USS- showing mass
Can also reveal free fluid and show ischaemia with colour doppler

151
Q

When is air insufflation contraindicated and surgery recommended in intussusception

A

Peritonitis
Perforation
HSP- known complication

152
Q

In post streptococcal glomerulonephritis what measure

A

C3, C4 and CH50
C3 very low and C4 normal

153
Q

What conditions cause psot strep glomerulonephritis

A

Pharyngitis
Impetigo

154
Q

What is whirlpool on USS of childs abdomen suggestive of

A

Malrotation

155
Q

Perianal fistula suggests what disease

A

Crohns

156
Q

Conditions associated with intussusception

A

Lymphoma
Gastroenteritis
HSP

157
Q

AXR findings of intussusception

A

paucity (less) of air in RUQ
thickened wall (oedema)
poorly defined liver edge
dilated small bowel loops

158
Q

Examination findings of intussusception

A

Sausage shaped mass
Dances sign- emptiness on palpation in RLQ

159
Q

What is a scaphoid abdomen and what seen in

A

Concave chest shape
Seen in malrotation

160
Q

Associations of malrotation

A

Congenital diaphragmatic hernia
Omphalocele

161
Q

Difference in cause of gastroenteritis- young child vs older

A

Young- viral (rotavirus)
Older- bacterial (e coli)

162
Q

Advice for toddlers diarrhoea

A

Encourage fibre intake

163
Q

Management of lactose intolerance

A

Refer to dietician
Encourage vit d and calcium intake

164
Q

How do inguinal hernias present

A

Lump in testicle, maybe on crying/laughing
On examination- can not get above it

165
Q

How to treat umbilical granuloma

A

Salt

166
Q

If have bilaterally undescended testes, what is ruled out

A

CAH
Disorders of sexual differentiation

167
Q

If on formula feeds, what is risk factor for gastroenteritis

A

Not sterilising water used to make up formula by boiling then cooling

168
Q

Mass in groin area with severe vomiting and tense abdomen

A

Incarcerated hernia

169
Q

Management of hepatitis A

A

Notify health protection agency
Encourage fluid intake

170
Q

Most common cause of delayed meconium passage

A

Meconium plug syndrome

171
Q

Causes of HTN in a child

A

Renal
- nephroblastoma
- CKD
- renal artery stenosis
Cardiac
- coarctation of aorta
Metabolic
- conns
- phaeo
- CAH

172
Q

What is preferred BP measurement in a child

A

Manual

173
Q

Management of 1 HTN reading in a child

A

Repeat

174
Q

Flank mass causing HTN in a child

A

Neuroblastoma of adrenal medulla
Measure urine catecholamine

175
Q

Anuria and enlarged bladder in a child

A

Posterior urethral valve causes backflow of urine entering urethra

176
Q

Other than renal problems what does AR PCKD do

A

Pulmonary hypoplasia
Hepatic fibrosis

177
Q

When is autosomal dominant PCKD picked up

A

Teenagers

178
Q

What is operation for testicular torsion

A

Bilateral orchidopexy

179
Q

Management of hydrocele in a child

A

Under 3 is fine- after if need to refer

180
Q

What are these 3 signs for appendicitis
- rosvings
- cough
- obturator

A

Rosvings- pain in RIF on left sided palpation
Cough- pain on voluntary cough
Obturator- pain on internal rotation when flex right thigh

181
Q

How long are upper vs lower UTIs treated for in kids

A

Lower- 3 days
Upper- 7 days

182
Q

What is operation done for very severe GORD

A

Nissen fundoplication

183
Q

How diagnose post strep glomerulonephritis

A

Anti-streptolysin titre
C3 and C4 levels as C3 low

184
Q

Imaging for wilms tumour

A

Initially do an USS
Then a CT to stage

185
Q

Best imaging for malrotation

A

Upper GI contrast

186
Q

How do abdominal migraines present

A

Severe umbilical pain which can intterfere with daily life
Associated with
- headache
- vomiting
- photophobia
- nausea
- anorexia
- pallor

187
Q

What is difference between regurgitation, GOR and GORD

A

Regurgitation involves bringing it up after feed
GOR= passage of stomach contents into oesophagus
GORD= GOR with symptoms of irritation

188
Q

What is a hydrocele

A

Collection of fluid within the tunica vaginalis

189
Q

What is management of hydatid torsion

A

Exploratory surgery as need to rule out torsion

190
Q

Management of undescended testicles

A

Bilateral
- urgent endo review
Unilateral
- recheck at 6 wk baby check, then 4-5 months and if not refer to surgeons

191
Q

Management of severe pyelonephritis

A

IV cefuroxime and gentamicin

192
Q

If have TOF or oesophageal atresia what is another malformation these are associated with

A

Anal atresia

193
Q

What do if measure childs bilirubin and is below phototherapy line but close

A

If unwell or 1 risk factor for neonatal jaundice keep in hospital and repeat in 18 hours
If none and seems well then come back in 24 hours

194
Q

Investigation for malrotation

A

Barium swallow

195
Q

What skin changes can be seen in neuroblastoma

A

Blueberry papules

196
Q

What investigation should be done on any child presenting with swelling or pain in testicle

A

USS to screen for cancer

197
Q

How can a urine culture be done on an infant

A

Urine collection pads

198
Q

Difference between neuroblastoma and nephroblastoma mass and presentation

A

In neuroblastoma will cross the midline
Neuroblastoma with present with fever, weight loss, diarrhoea and vomiting- generally very unwell

199
Q

How other than recurrent UTIs can VUR present

A

Enuresis
Incontinence

200
Q

How does mesenteric adenitis present

A

Post URTI
- can be acute abdo pain
- lymphadenopathy

201
Q

How is mesenteric adenitis investigated

A

Abdo USS showing mesenteric thickening

202
Q

What can precipitate transient proteinuria

A

Seizures
Infections
Pregnancy
Exercise

203
Q

What is risk of hydrocele

A

Inguinal hernias

204
Q

What counts as daytime symptoms in a child

A

Wetting themselves
Passing urine over 7x a day

205
Q

Most sensitive investigation for intussusception

A

Contrast enema

206
Q

Management of VUR

A

Refer to paediatric surgeons

Paeds (17 decks)

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