Paediatric Flashcards

Question

what should every child with cerebral palsy get?

Answer 1

An MRI brain - may show periventricular leukomalacia

Answer 2

Safety net - if vomiting becomes projectile, bile stained or bloody, poor growth or persisits beyond 1 yr and come back - referral for breastfeeding assessment if frequent regurg with distress reduce feed volume to trial smaller more frequent amounts - if persists can try feed thickeners or anti-regurg formulae - option of trialling hydrolysed protein formula to rule out cows milk protein intolerance - education - prone and lateral positions decrease reflux but increased risk od SIDs - PPIs or H2 antagonists may be trialled - enteral feeding if medical management unsuccessful - Surgical management is uncommon - nissen fundoplication

Answer 3

2-6 week dietary modification trial | skin prick testing can be used

Answer 4

10% will be sensitive to soya but can be used in lactose intolerance but not under 6months

Answer 5

Lactose intolerance can be primary, requiring lifelong dietary modification. Secondary lactose intolerance is usually transient following a viral infection of the GI tract, and the short-term use of a low lactose or lactose-free formula for 6-8 weeks can help to relieve symptoms.

Answer 6

his may be IgE mediated, in which case there is a rapid reaction to cow’s milk, occurring within 2 hours of ingestion. It can also be non-IgE medicated, with reactions occurring slowly over several days.

Answer 7

lactose intolerance and cow’s milk intolerance. People with cow’s milk protein allergy do not have an allergy to lactose. Lactose is a sugar, not a protein. Cow’s milk intolerance is not an allergic process and does not involve the immune system. Therefore will not have allergic sc such as rash, angio-oedeam, coughing and sneezing

Answer 8

Breast feeding mothers should avoid dairy products Replace formula with special hydrolysed formulas designed for cow’s milk allergy most will outgrowthe allergy by age 3 every 6 months or so trial children on first steps pf the milk ladder - e.g. malted milk biscuits and slowly progress until sx resolve

Answer 9

infants younger than 3 months with a temperature above 38ºC or 3 – 6 months with a temperature higher than 39ºC.

Answer 10

Always safety-net, offering education and advice to patients and parents on when to seek further medical attention. Simple analgesia for pain and fever Most will resolve in 3 days and may not require Abx Consider prescribing antibiotics at the initial presentation in patients who have significant co-morbidities, are systemically unwell or are immunocompromised. Children less than 2 years with bilateral otitis media and children with otorrhoea (discharge) are more likely to benefit from antibiotics. can consider delayed prescription to collect after 3 days if sx havent improved 1st line = amoxicillin = erythromycin.

Answer 11

Eczema is a chronic, relapsing disease, and educating patients and their families is necessary so that they develop an understanding of basic skin care and how to avoid trigger factors.

Answer 12

Step wise approach education e.g. avoid activities that break down skin barrier - bathing in hot water, scratching, scrubbing Emollients (Diprobase) , topical corticosteroids (lowest potency), calcineurin inhibitors (e.g. tacrolimus) Treat any bacterial infections. Flares can be treated with thicker emollients = wet wraps Coal tar, UV light therapy and systemic immunosuppresants can be used (e.g. ciclosporin)

Answer 13

By decreasing the dryness and improving the barrier function of the skin, emollients can improve symptoms of itch and pain, in addition to decreasing exposure to bacteria and sensitising antigens. Applying emollients after bathing may help to retain the moisture in the skin.

Answer 14

- FBC and blood smear - IgA-tTG and IgA levels - endomysial antibody - BMJ also advises to biopsy and skin lesions suggestive of dermatitis herpetiformis - small bowel endoscopy and histology

Answer 15

atrophy and scalloping of mucosal folds

Answer 16

patient education - risk stratification - strict gluten free diet - vitamin and mineral supplementation - iron, VitD, vit B12 and folate, calcium - assess bone mineral density after 1 year to assess for osteoporosis - if no response to gluten free diet refer to gastroenterologist

Answer 17

SABA 15 mons before exercise Increase asthma medication with preventer Non-pharm methods - training, sufficient warm-up exercise, and, if exercising in cold weather, breathing through a face mask or scarf to pre-warm and humidify air, and dietary modification Check inhaler technique and adherence

Answer 18

A typical presentation is a child around 18 (always under 5 yrs) months of age presenting with a 2 – 5 minute tonic clonic seizure during a high fever. The fever is usually caused by an underlying viral illness or bacterial infection such as tonsillitis. Once a diagnosis of a febrile convulsion has been made, look for the underlying source of infection.

Answer 19

- identify cause - antipyretic agent If complex febrile seizures - ibruprofen until fever sedates - diazepam may be given if repeated seizures occur Low threshold for paed referral Long-term management requires thorough assessment and risk stratification to devise a customised plan for each child, paying attention to the carer situation at home and day care Systematic reviews show no benefit of antiepileptic or antipyretic tx

Answer 20

diagnosis is clinical may wnat to identify source of fever could consider - LP - rule out meningitis - blood culture - eeg - brain MRI - viral studies

Answer 21

correct abnormalities in oxygen and hydration - treatment is primarily supportive Hospital admission if hypoxeamia, tachypneoa that is so severe it restricts oral feeding or hyrdation if risk of aspiration = IV or NG tube mechanical ventilation may be required IV fluids in caution if prior hx of wheeze give oral corticosteorids Palivizumab for those at high risk in RSV season

Answer 22

vesicoureteral reflex

Answer 23

US - all children under 6 months if 1 UTI, or children with recurrent or atypical UTIs. DMSA - 4-6 months after illness to assess damage if recurretn or atypical UTI Micturating cystourethrogram - MCUG to diagnose Vesico-ureteric reflux

Answer 24

if less than 6 weeks admit and rule out sepsis/meningitis evaluation - give IV ampicillin and gentamycin unless meningitis is suspected generally over age of 6 weeks use 3rd generation cephalosporin tx course is usually 7-10 days in neonates,infants and children and 3 days in adolescents

Answer 25

Two or more episodes of acute pyelonephritis, or One episode of acute pyelonephritis plus at least one episode of cystitis, or Three or more episodes of cystitis

Answer 26

diabetes, medications, emotional problems, urinary tract infection, spina bifida, seizure disorder, and neurogenic bladder.

Answer 27

Education - star chart Behavioural and lifestyle - limit fluid in the evening and caffienated drinks + regular voiding habits in the day Active tx is only offered to children over the age of 7 yrs 15% will spontanously cure wihtin the yr bladder training therapy via a trained urotherapist Enuresis alarm Desmopressin can be tried.

Answer 28

faecal impaction, faecal and urinary incontinence, UTI and occassionaly abdo pain

Answer 29

softening stool with laxatives and faecal softeners improving water, food and fibre intake address anxiety in both parent and child - parents forcing children may be ineffective as voiding is painful for the child regular toilet habits and behvioural modification are important aspects of treatment - e.g. unhurried time of the toilet If impaction and persistent constipation surgery may be required e..g endoscopic

Answer 30

parainfluenza 2,3

Answer 31

barking seal like cough

Answer 32

Dexamethasone - 0.15-0.6 mg/kg as a single dose. Avoid agitation, parental assurance and eduactin to the self limiting nature of the illness. In moderate cases nebulised adrenaline is used in severe cases supplementary oxygen and intubation may be used mild to moderate cases can be discharged home after 2-4 hours of obs if significant respiratory distress pts require continous observations

Answer 33

FBC - if WBC raised suggests severe cases PCR of nasopharyngeal aspirate culture from nose swab

Answer 34

azithromycin or clarithromycin advised to complete full course of abx counsel of risks of side effects - cough may persist for several months pneumonia and bronchiectasis and safety net Notifiable disease supportive care prophylactic abx in close contacts if vulnearable groups

Answer 35

varicella zoster = highly contagious

Answer 36

Chickenpox is usually a mild self limiting condition that does not require treatment in otherwise healthy children. Aciclovir may be considered in immunocompromised patients, adults and adolescents over 14 years presenting within 24 hours, neonates or those at risk of complications. Complications such as encephalitis require admission for inpatient management. Symptoms of itching can be treated with calamine lotion and chlorphenamine (antihistamine). Patients should be kept off school and avoid pregnant women and immunocompromised patients until all the lesions are dry and crusted over. This is usually around 5 days after the rash appears.

Answer 37

most common congenital abnormality of small bowel. May be asymptomatic for life or present before age of 2. Failure of vitelline duct to obliterate

Answer 38

age <2yrs passage of bright red blood per rectum intractable constipation

Answer 39

Meckels scan FBC plain abdo xray, US

Answer 40

asymptomatic dont tx unless found during a non-acute operation If symptomatic = resection as progression of diverticulitis can = perforation or peritonitis

Answer 41

``` doesnt smile at 10 weeks cannot sit unsupported at 12 months cannot walk at 18 months new onset gait abnormality any sign of developmental regression hand preference before 12 m - may suggest cerebral plalsy persistence of primative reflexes >12 m ```