Miscellaneous Flashcards

Question

Indications for Abx therapy in AOM

Answer 1

- ATSI - < 6/12 - Bilateral infection < 2yo - Systemically unwell (lethargy, pain, irritability) - Otorrhoea present - Immunocompromised

Answer 2

Midline neck mass at level of thyrohyoid membrane - Non-tender mass within 2cm of midline. - Moves with swallowing and protrusion of tongue. - Most have some degree of infection or inflammation present.

Answer 3

Differential - Constiutional Delay - Familial Short stature - Pathological causes in 15% of cases - Growth hormone deficiency - Hypothyroidism - Malnutrition - Intrauterine growth retardation. - Chronic systemic disease - Congenital adrenal hyperplasia - Genetic (Turner, Syndrome) - Consider blood testing if child is significantly short relative to their family or is growing slowly. - Random growth hormone is not useful due to pulsatile nature of secretion. Test with plasma insulin-like growth factor 1 (IGF-1) - Cushing Syndrome Consider specialist referral if: - Height is below 1st percentile - Significantly shorter than expected in context of parental height - Growth velocity is abnormally low. Mid-parental height measurement is indication of child's final adult height. For boy - (father+ mother + 13 )/2 For girls - (father + mother - 13)/2

Answer 4

Displacement of capital femoral epiphysis from metaphysis - Characterisation - Stable or unstable (unable to weightbear even with crutches) - Acute, Chronic (Progression of symptoms > 3 weeks.) - Risk - M > F, Mean age 13.5 years for bys and 12 for girls - Weight (95th percentile) have 50% of cases. - Can happen bilaterally in 20-50% of cases. Clinical presentation - Antalgic gait. - Out-toeing and shortening of affected limb. - Obligatory external rotation and abduction during flexion of the hip. - Vague pain in groin, thigh or knee Ix - Pelvic xray, cross-table lateral x-ray in acute slip, frogleg lateral xray in chronic slip (Frog-leg can disrupt vascular supply to head of femur in acute slip) Complications - Osteonecrosis in 50% of unstable SUFE even with treatment - Chondrolysis - Osteoarthritis - Femoral acetabular impingement Treatment - Make non-weightbearing to reduce likelihood of further slippage. - Urgent review by Ortho to discuss internal fixation with in-situ pinning of the hip.

Answer 5

Symptoms - Itchy vaginal area - Some discharge - Redness of skin between labia majora - Dysuria Increased likelihood in female children as lining of vagina and vulva are thin and can be easily irritated. Risk factors - Tight clothing - Obesity - Irritants - Soap residue, bubble baths, antiseptics - Concomitant threadworms Management - Loss cotton underwear / Avoid tight jeans - Maintain healthy weight - Avoid use of soap in bath or shower. / Ensure vulva is well-rinsed - Vinegar sitz baths 15mins daily for a few fays - Sudocreme use daily

Answer 6

Impact to genital area in children. - In pre-pubertal females, genital tissue is friable with excellent blood flow. Minor injury can cause bleeding History questions to ask - Mechanism of injury - Timing and setting of injury - First aid provided - Inability to pass urine or faeces - Other injuries - Witnesses - Consider if injury is consistent with history or if there is suspicion of NAI Management - Sitz bath - Avoid strenuous activity for 24 hours (re-injury minimisation) - Minimise direct pressure to area - Ice pack to minimise swelling. - Analgesia - Ibuprofen / Paracetamol - Topical anaesthetic cream. Non-minor injuries? - Ongoing bleeding, laceration borders not visualised, labia minora tear, unable to void, clinical concern -> Admission to hospital under paediatrics and consider urethral catheter if inability to void or large vulval haematoma.

Answer 7

Acronym - P - Peak of crying at 6-8 weeks and improves by 3-4 months - U - Unexpected - Crying can come and go and you don't know why - R - Resists Soothing - - P - Pain-like Face - May look like they are in pain even when they are not - L - Long-lasting - Lasts as much as 5 hours a day - E - Evening - Worse in late afternoon and Evening Educational Notes to discuss with parents - Crying is normal physiological behaviour in young infants. - At 6-8 weeks of age, babies are expected to cry for 2-3 hours in 24 hours. Techniques to assist with comfort of child - Establish pattern to feeding/settling/sleep - Predictable settling for naps e.g. Quiet play -> Move to bedroom -> Give baby cuddle -> Settle in cot whilst awake - Avoid excessive stimulation - Noise / light / handling - Darken the room for daytime sleeps - Baby massage / rocking / patting - Respond before the baby is too worked up. - Give primary carer respite once a day Recommend against following empiric treatment for crying - Anti-reflux medication - Not effective compared to placebo - Anticholinergics - Effective by SE of apnoeas and seizures - Gripe water - No proven benefit - Simethicone - No effect compared to placebo - Limited evidence to support probiotic use.

Answer 8

- Positive cover test - Unequal corneal light reflex - Unequal red reflex - Abnormal head tilt - Impaired extraocular movement - Positive cover/uncover test (Use to find latent strabismus)

Answer 9

Inflammation at the tip of the foreskin. and glans of the penis Causes - Chemical irritation (urine trapping, soiled nappies, soap residue - Physical trauma - Forcible Retraction - Candida Treatment - Soaking in salt water bath settles swelling and discomfort - Consider barrier cream or 1% hydrocortisone if concern for nappy rash - Consider clotrimazole if candida suspected - Oral analgesia - Avoid retraction of foreskin.

Answer 10

-pathological phimosis - Recurrent UTIs - Parent preference Complications - Infection - Bleeding

Answer 11

Calcaneal Traction Apophysitis - Common cause of heel pain in childhood and early adolescence. - Increased risk with high activity level with sports that involve running and jumping. Symptoms - Limp. Complain of pain during or after activity. - Can be unilateral or bilateral Imaging not necessary. Clinical diagnosis. Management - Modify activities that cause pain. - Ice packs - Insert gel heel pad into shoes - Daily calf-stretching exercises. Pain normally settles in 6-12 months but can last up to 2 years.

Answer 12

Sudden, rapid, recurrent involuntary vocalisations or movements Included behaviours - Grunting, blinking, shrugging shoulders, humming, yelling out a word or phrase, clearing the throat Classification - Tourette Syndrome - Motor and vocal tics for > 1 year - Provisional Tic Disorder - Motor or vocal tics for < 1 year - Persistent motor or vocal tic disorder - Motor or vocal tics for > 1 year - Average age of onset 5-6 years - Associated with psychosocial distress and poor functioning. - Strong genetic component. - Associated with ADHD or OCD. No treatment other than psychosocial support and treating co-morbidities.

Answer 13

Normal physiological development of legs in children Bow legs (Genu Varum) - Toddlers -> 3yo - Monitor intercondylar (medial condyle of knees) separation. if > 6cm at 4 years, refer. Knock knees (Genu valgum) - Normal 2-8yo - Running is awkward but improves with time. - Refer if intermalleolar separation is > 8cm.

Answer 14

Dramatic awakening during the night in the first few hours of sleep - 5% of children will have night terrors. - Usually occur in pre-school and primary school. - No long-term effects

Answer 15

Radial Head Subluxation Signs - Not using affected limb - Elbow in extension and forearm in pronation - Distressed only on elbow movement - No associated swelling, deformity or bruising. - Resistance and pain on supination of forearm Rx - Reduction manoeuvre - Supination and flexion - Thumb on radial head. Fully supinate arm and then flex arm. Should feel a click with relocation.

Answer 16

Inflammation of distal colon in response to food proteins. - Common triggers - Cow's milk, soy. Clinical Signs - Haematochezia in otherwise healthy infant. - Anal fissures Rx - Elimination diet.

Answer 17

Lack of activity of enzyme lactase used to digest disaccharide lactose. Instead, lactose is converted by bacteria in colon to hydrogen gas and short-chain fatty acids. High prevalence in African Americans, hispanics, Asians, Native Americans. Symptoms - Abdominal pain, bloating, flatulence. Clinical diagnosis based upon suspicion of symptoms. - Ix - Can consider Lactose hydrogen breath test Rx - Restriction of lactose to two cups of milk per day taken in divided doses. - Can consider use of lactase supplements. - Consider calcium supplementation due to inadequate dietary calcium intake through restriction.