meconium aspiration syndrome

Question 1

An infant born at 41 weeks gestation has respiratory distress shortly after birth. The amniotic fluid during labor is noted to be darkly stained. Shortly after the infant develops significant respiratory distress and desaturates rapidly. Given the most likely diagnosis, what complication has occurred?

Answer 1

Meconium aspiration syndrome is associated with high rates of air leak, pneumothorax and pneumomediastinum. The sudden development of profound respiratory distress suggests pneumothorax

can be resp infection but slower onset

Question 2

mesenteric adenitis

Answer 2

Mesenteric adenitis can present similarly to appendicitis with non-specific abdominal pain, however guarding is rare, and it would not produce a septic picture. It usually follows an upper respiratory tract infection, and children are often well otherwise, with no change in appetite

Question 3

vomtiign children differentials

Answer 3

Posseting
In infants, simple small volume vomits of milky fluid (posseting) is extremely common after feeds.

GORD
Larger volume regurgitation may represent gastroesophageal reflux disease, which is initially managed conservatively with positioning and burping advice.

Infection
More forceful vomits in infancy can be a non-specific sign of infection. Examples include gastroenteritis, pneumonia, acute otitis media, tonsillitis, meningitis or urinary tract infection.
For this reason, a thorough examination including an ENT examination is usually recommended for very young children presenting with vomiting

Whooping cough
Vomiting after prolonged periods of coughing in an unvaccinated child is suggestive of whooping cough (Bordetella pertussis infection).

Pyloric stenosis
Projectile vomiting in young boys with a palpable olive mass whilst feeding at 6-8 weeks of age is suggestive of pyloric stenosis, which requires surgical management.

GI Obstruction
Bilious vomiting suggests obstruction, for example from malrotation.

Appendicitis
Vomiting combined with central abdominal pain that moves to localise to the right iliac fossa is suggestive of appendicitis.

Testicular Torsion
Testicular torsion may present with testicular/abdominal pain and vomiting.

Brain tumour
Vomiting, especially if coupled with other neurological signs/symptoms, might indicate a space-occupying lesion caused by a tumour

In older children and teenagers, additional causes of acute vomiting - diabetic ketoacidosis, cyclical vomiting and migraine. Early morning headaches and vomiting suggests raised intracranial pressure. In teenagers, it is important to take a wider approach and consider alcohol, drug use (especially cannabis), bulimia and pregnancy.

Question 4

ground glass

Answer 4

repsiraotry distress sydnrome - dexamethasone