Paediatrics 2 Flashcards
Rashes & infectious diseases Endocrine
1
Q
When does the rash associated with measles appear?
A
3-4 after symptom onset
2
Q
School exclusion criteria for measles
A
4 days after rash onset
3
Q
Measles causative organism
A
RNA paramyxovirus
4
Q
Measles clinical manifestations
A
Maculopapular rash behind ears - spreads and becomes confluent
Koplik spots
Conjunctivitis
Irritable
5
Q
Measles investigations
A
< 3 days: PCR for measles mRNA
> 3 days: IgM/IgG antibodies
6
Q
Post-measles complications
A
Otitis media
Pneumonia
Myocarditis
Encephalitis
Subacute sclerosing panencephalitis - 5-10 years later
7
Q
Dawson disease
A
Subacute sclerosing panencephalitis
8
Q
School exclusion criteria for measles
A
4 days after rash onset
9
Q
Rubella causative organism
A
Togavirus - rubivirus
10
Q
School exclusion criteria for rubella
A
5 days after rash onset
11
Q
Rubella clinical manifestations
A
Maculopapular rash on face - spreads to body
Lymphadenopathy
Forchheimer spots
12
Q
Congenital rubella syndrome
A
Sensorineural deafness
Cataracts
PDA
13
Q
Complications post-rubella
A
Thrombocytopaenia
Encephalitis
Myocarditis
Arthritis of small joints
14
Q
When is rubella vaccinated against?
A
MMR:
12-13 months
2-3 years old
15
Q
Rubella incubation period
A
14-21 days
16
Q
Rubella investigations
A
PCR
IgM antibodies
17
Q
Erythema infectiosum: alternative names
A
5th disease
Slapped cheek syndrome
18
Q
Describe the rash associated with erythema infectiosum
A
On face (slapped cheeks)
Spreads to trunk and limbs (lacy)
19
Q
Erythema infectiosum causative organism
A
Parvovirus B19
20
Q
Erythema infectiosum school exclusion criteria
A
No school exclusion
21
Q
Roseola infantum symptoms
A
Extremely high fever
to
Rash on trunk to extremities
Febrile convulsions
22
Q
Roseola infantum epidemiology
A
6 months - 2 years
23
Q
Roseola infantum causative organism
A
HHV6
24
Q
Roseola infantum complications
A
Aseptic meningitis
Hepatitis
25
Roseola infantum school exclusion criteria
No school exclusion
26
Hand, foot and mouth disease causative organisms
Coxsackie A16 virus
Enterovirus 71
27
Hand, foot and mouth disease school exclusion
No school exclusion
28
Hand, foot and mouth disease complications
Viral meningitis
Encephalitis
29
Herpangina
Coxsackie A affecting mouth only
30
Why should ibuprofen be avoided in children with chickenpox?
Increase risk of necrotising enterocolitis
31
Chicken pox rash
Itchy, starting on head/trunk and spreads
Macular -> papular and vesicular
32
Congenital varicella syndrome
Limb atrophy
Ocular defects
Neurological defects
33
Chicken pox complications
Secondary bacterial infection of lesions – B-haemolytic Group A Strep
Encephalitis
Disseminated haemorrhagic chickenpox
Pneumonia
34
Chicken pox school exclusion criteria
Until lesions have crusted over
35
Meningitis investigations
Blood cultures
LP
36
Meningitis antibiotics
< 3 months: amoxicilln (listeria) + cefotaxime
> 3 months: cefotaxime / ceftriaxone
37
Meningitis prophylactic antibiotics
1st: Ciprofloxacin single dose
2nd: Rifampicin 2 days
38
Indication for benzylpenicllin for meningitis
Menogococcal meningitis
Non-blanching rash
39
Most common complication after meningitis
Sensorineural hearing loss
40
Cause of purpura/petechiae
Dermal capillary micro thrombi that rapidly lead to haemorrhagic skin necrosis
Endotoxin released by bacteria which induced oedema formation and capillary thrombosis with extravasation of blood into interstitial space
41
Close contact
Same household during 7 days before onset of illness
Anyone in direct contact with patient’s oral secretions
42
Waterhouse-Friedrichsen syndrome
Adrenal gland failure which can occur after meningitis
43
HSP pathophysiology
IgA mediated small vessel vasculitis
44
HSP clinical manifestations
After viral URTI
Purpural rash
Abdominal pain
Joint pain
Haematuria +/- proteinuria (nephritis)
45
Describe the rash associated with HSP
Purpural, non-blanching
Buttocks, back, legs, trunk spared
46
HSP management
Usually self-limiting
NSAIDs can be given for arthalgia
Steroids can be used
47
2 causes of desquamating rash
Scarlet fever
Kawasaki disease
48
Diagnostic critieria for Kawasaki disease.
Fever (>38.5) for > 5 days and at least 4 of:
- Conjunctivitis – bilateral (spares limbus)
- Rash – non-vesicular
- Cervical lymphadenopathy
- Strawberry tongue / cracked lips
- Hands & feet – swollen
49
Kawasaki disease management
High dose oral aspirin
IV immunoglobulin
50
Investigation of complications after Kawasaki disease
Echocardiogram for coronary artery aneurysm
51
Describe the conjunctivitis seen in Kawasaki disease
Bilateral
Spared limbus
52
Kawasaki disease complications
Coronary artery aneurysm
Reye syndrome
53
Pathophysiology of coronary artery aneurysm after Kawasaki disease
Fibrin deposited on blood vessel wall
Can’t gently stress
Bulges form ->
Coronary aneurysm
54
Reye syndrome aetiology + pathophysiology
Associated with aspirin use in children
Due to mitochondrial dysfunction
55
Reye syndrome features
After a viral infection / aspirin use
Non-inflammatory encephalopathy - slurred speech, lethargy
Fatty degeneration of liver - abnormal LFTs
Cerebral oedema - raised ICP
56
Reye syndrome diagnosis
Liver biopsy
57
Scarlet fever causative organism
Group A streptococci
Usually strep pyogenes
58
Scarlet fever school exclusion criteria
Return 24 hours after starting antibiotics
59
Scarlet fever: describe the rash
Neck to trunk & limbs
Fine punctuate erythema surrounding area around mouth
Sandpaper texture
Desquamation after 1 week
60
Scarlet fever clinical manifestations
Fever
Malaise
Strawberry tongue - red with white bits
Tonsilitis
61
Scarlet fever investigations
Throat swab
Increased anti streptolysin O (ASO)
62
Scarlet fever management
Give Abx before results of throat swab
Oral penicillin 10 days
Alternative azithromycin
Notifiable disease
Return to school 24 hours after Abx
63
Peak age of presentation of scarlet fever
4 years
64
Scarlet fever complications
Rheumatic fever - 20 days later
Otitis media
Acute glomerulonephritis
PANDAS
65
Mumps causative organism
RNA paramyxovirus
66
Mumps clinical manifestations
Parotitis (unilateral then bilateral in 70%)
Fever, malaise, muscular pain
67
Mumps school exclusion criteria
5 days after onset of swollen glands
68
Mumps complications
Orchitis 1 in 3
Viral meningitis 1 in 4
Hearing loss 1 in 25
Pancreatitis 1 in 25
Encephalitis 1 in 1000
69
Vaccines in the 6-in-1 vaccine
Polio
Whooping cough
Influenzae (HiB)
Tetanus
Hep B
Diphtheria
[DT, double P, double HB]
70
Whooping cough causative organism
Gram -ve Bordetella pertussis
71
Whooping cough school exclusion criteria
48 hours after starting antibiotics
Or 3 weeks from symptom onset
72
Whooping cough management
Azithromycin or clarithromycin
Only if cough within 3 weeks of start (otherwise supportive)
Also for household contacts
Vaccine for women 16-32 weeks pregnant
73
Whooping cough diagnostic criteria
Cough > 14 days and 1 of:
Paroxysmal cough
Inspiratory whoop
Post-tussive vomiting
Apnoeic attacks in young infants
74
Why is erythromycin not used for whooping cough?
Associated with hypertrophic pyloric stenosis
75
Threadworms causative organism
Enterobius vermicularis
76
Threadworms infection symptoms
Anal & vulval itching
Visible white worms in faeces
90% are asymptomatic
77
Threadworms investigation
Microscopy - sellotape to perianal area
Usually treated empirically
78
Threadworms school exclusion criteria
No school exclusion
79
Threadworms management
Single dose oral mebendazole for entire household > 6 months + hygiene advice
80
Contraindication to mebendazole for threadworms
< 6 months old
81
Contraindication to mebendazole for threadworms
< 6 months old
82
Steroids escalation
Hydrocortisone
Clobetasone
Betamethasone
Mometasone
Clobetasol
83
Eczema presentation in different ages
Infants: trunk and face
Younger children: extensor surfaces
Older children: flexor surfaces
84
Eczema management
1st: Simple emollients
2nd: Topical steroids
3rd: Immunosuppressants, topical calcineurin inhibitors
85
Eczema herpeticum
Dermatological emergency
Eczema infected with HSV
Acyclovir
86
Pityriasis rosea features
Herald patch - single pink scaly patch
Self-limiting
87
Head lice organism + management + diagnosis
Pediculus capitum
1st line: wet combing / malathion
No school exclusion
Fine tooth combing of wet / dry hair
88
Management of urticaria
Hives
Antihistamines +/- steroids
Usually self limiting
89
Impetigo appearance + management (treatment and school exclusion)
'Golden crusted' lesions arouns mouth
If well: benzoyl/hydrogen peroxide 1% cream
If signs of infection: fusidic acid or mupirocin
If systemically unwell: oral flucloxacillin (or erythromycin)
School exclusion:
Until lesions are crusted and healed, or 48 hours
after commencing antibiotic treatment
90
Impetigo causative organism
Staph aureus
91
Infective mononucleosis causative organism + diagnosis
EBV
FBC or Paul Bunnell/Monospot test +ve
92
Pityriasis versicolor causative organism
Malassezia furfur
93
Pityriasis versicolor appearance + treatment
Hypopigmentation patches (more noticeable after suntan)
Antifungals e.g. ketoconazole shampoo
2nd: itraconazole + send scrapings for diagnosis
94
Scabies causative organism + appearance
Sarcoptes scabei
Tracks and burrowing between finger webs
95
Scabies management
Whole family
1st: Permethrin cream 8-12 hours
Repeat 1 week later
2nd: malathion
Ivermectin for crusted scabies
School exclusion until treatment complete
96
Molluscum contagiosum management
Self-limiting + emollients
97
DKA investigations
Acidosis: pH < 7.3 & bicarbonate < 15mmol/L
Hyperglycaemia > 11mmol/L (unless known diabetic)
Ketonaemia - blood ketones > 3 mmol/L
Electrolytes
98
DKA severity by pH
pH < 7.1 – severe DKA (10% dehydration)
pH < 7.2 – moderate DKA (5% dehydration)
pH < 7.3 – mild DKA (5% dehydration)
99
DKA management
Fluid resuscitation – 0.9% NaCl – over 48 hours (+ bolus - do not subtract if shocked)
Insulin infusion – 0.1 units/kg/h
Potassium replacement and cardiac monitoring
100
DKA complications
Cerebral oedema
Hypokalaemia
Hypoglycaemia
Aspiration pneumonia
Death
101
DKA: how does cerebral oedema present?
Headache
Agitation
Low HR + higher BP
Decreased consciousness
Pupillary inequality or dilation
102
DKA: management of cerebral oedema
Hypertonic saline
Or mannitol
Restrict fluid to half of maintenance rates
103
Guthrie test: which conditions are screened for?
Congenital hypothyroidism
Sickle cell anaemia
Cystic fibrosis
Glutaric aciduria
Homocystinuria
Isovaleric aciduria
Phenylketonuria
Maple syrup urine disease
MCAD
104
Congenital hypothyroidism clinical manifestations
Puffy face
Macroglossia
Goitre
Hypotonia
Constipation
Prolonged jaundice
Feeding problems
Umbilical hernia
105
Congenital hypothyroidism - which type of bilirubinaemia is seen?
Unconjugated hyperbilirubinaemia
106
3 sub types of CAH in order of prevalence
21-hydroxylase deficiency
11-beta hydroxylase deficiency
17-hydroxylase deficiency
107
Mode of inheritance of CAH
Autosomal recessive
108
Action of 21-hydroxylase enzyme
Converts 17α-hydroxyprogesterone to 11-deoxycortisol in glucocorticoid pathway
Converts progesterone to 11-deoxycorticosterone in the mineralocorticoid pathway
109
% chance of 2 homozygous recessive parents for CAH 21-hydroxylase deficiency having a child with ambiguous genitalia?
1/8
Breakdown:
1/4 chance of CAH
1/2 chance of XX child
1/4 x 1/2 = 1/8
110
Clinical manifestations of 21-hydroxylase deficiency + gene affected
Ambiguous genitalia (XX) or precocious puberty (XY)
Salt-wasting
CY212A2 gene mutation
111
Clinical manifestations of 11-beta hydroxylase deficiency
Ambiguous genitalia (XX) or precocious puberty (XY)
Hypertension
112
Clinical manifestations of 17-hydroxylase deficiency
Abscence of secondary sex characteristic, amenorrhoea, infertility (XX) or inter-sex (XY)
Hypertension
113
Biochemical abnormalities seen in salt-wasting CAH
Lack of aldosterone production
Low Na and high K
Metabolic acidosis on ABG
Hypoglycaemia
114
Management of salt-wasting CAH
Hydrocortisone (double dose in illness)
Fludrocortisone
Monitor growth, skeletal maturity and plasma androgens
115
Pathological causes of obesity in children
Growth hormone deficiency
Hypothyroidism
Down's syndrome
Cushing's syndrome
Prader-Willi syndrome
116
Measuring obesity in children
< 2 years: weight to length ratio
> 2 years: BMI to age
117
First sign of onset of puberty in boys
Testicular growth: > 4ml
118
First sign of onset of puberty in girls
Breast budding
119
Tanner staging: female
I - none
II - breast buds form being areolas
III - breast buds elevate beyond areola
IV - areola mounds form and project
V - mounds reduce, adult breasts form
120
Tanner staging: male
I - testicular volume < 4ml
II - testicular volume ≥ 4ml, scrotum - enlarges, redens and change in texture
III - penis lengthens, testicular volume ≥ 10ml
IV - penis size increases (length and breadth), development of glans, testicular volume ≥ 16ml, scrotal skin darker
V - adult genitalia
121
Precocious puberty age for diagnosis
Before 8 in females
Before 9 in males
122
Classification of precocious puberty
Gonadotrophin dependent (central/true)
Due to premature activation of hypothalamic-pituitary-gonadal axis
Increase FSH and LH
Gonadotrophin independent (pseudo/false)
Due to excess sex hormones
Increase FSH and LH
123
Precocious puberty: different testes appearance in males
Bilateral enlargement – gonadotrophin release from intracranial lesion
Unilateral enlargement – gonadal tumour
Small testes – adrenal cause
124
Androgen insensitivity syndrome karyotype + mode of inheritance
46XY
X-linked recessive
125
Androgen insensitivity syndrome: why can breast development still occur?
Testosterone can be converted to oestradiol
126
Management of undescended testes
Unilateral
Re-examine 6-8 weeks
Re-examine at 4-5 months
Referral to paed surgery or urology and seen by 6 months
Bilateral
Review within 24 hours by senior paediatrician
If no DSD present – see in 6-8 weeks then urgent surgery 2ww
127
Undescended testes: increased risk of what conditions?
Infertility
Testicular torsion
Testicular cancer
128
Undescended testes: what % of cases are bilateral?
25%
129
Undescended testes: types
Rectractile: testis is not present in scrotum but can be manipulated into scrotum before retracting again
Palpable: testis can be palpated in groin but cannot be manipulated into scrotum
Impalpable: no testis can be felt, and may lie in the inguinal canal, intra-abdominally, or be absent
130
Predisposing factors for undescended testes
Prematurity
LBW
SGA
Family history
Maternal smoking during pregnancy
131
Surgical correction for undescended testes
Orchidoplexy
132
Neonatal resuscitation steps
Dry baby
5 inflation breaths
Re-assess
Recheck head position
Repeat inflation breaths
Chest compressions 3:1 if HR < 60
133
Drugs used in neonatal resuscitation
Adrenaline 1:10000
Glucose
Sodium bicarbonate
IV fluids
134
Antibiotics used in necrotising enterocolitis
Broad spectrum e.g. cefotaxime and vancomycin
135
Necrotising enterocolitis presentation
Bilious vomiting
Blood in stools
Neonatal age
Distended abdomen
Shock
Food intolerance
136
Risk factors for developing necrotising enterocolitis
SGA/IUGR/LBW
Prematurity
Formula feeds
Sepsis
PDA and other CHD
Co-amoxiclav use in pregnancy
137
Necrotising enterocolitis diagnostic investigation + findings
Abdominal Xray
Dilated bowel loops
Pneumatosis intestinalis
Pneumoperitoneum
138
Complications of necrotising enterocolitis
Perforation
Peritonitis
Stoma
Short bowel syndrome
139
APGAR scoring
Activity
Pulse
Grimace
Appearance
Respiration
140
Management of respiratory distress syndrome
1. O2
2. Intubate
3. CO2 monitoring
4. Surfactant therapy – intratracheal instillation
5. Nasal CPAP and mechanical ventilation
6. Fluids if indicated
141
Management of transient tachypnoea of the newborn
Supportive management
142
Xray findings seen in transient tachypnoea of the newborn
Fluid in horizontal fissure
Hyperinflation of lungs
143
Meconium aspiration syndrome presentation
Meconium stained liquor
Respiratory distress
144
Meconium aspiration syndrome Xray findings
Patch infiltrations
Atelectasis
145
Meconium aspiration complications
Pneumothorax / pneumomediastinum from air leak
Persistent pulmonary hypertension of newborn
Respiratory tract infection
146
Causative organisms of early onset (< 72 h) neonatal sepsis
GBS
E. Coli
P. Aeruginosa
147
Causative organisms of late onset (> 72 h) neonatal sepsis
S. Aureus
S. Epidermis
Pseudomonas
148
Sepsis 6
Blood culture
FBC
CRP
Blood gases
Urine MCS
LP
149
Indications for fluid bolus for neonatal sepsis
Shock
Lactate > 2mmol/L
150
Neonatal jaundice < 24 hours old
Always pathological
151
Neonatal jaundice investigations
SBR > 80 µmol/L
FBC and film
Direct Coomb's test
152
3 causes of neonatal jaundice < 24 hours
Sepsis
Haemolytic cause
Congenital infection
Cephalohaematoma
153
Mechanism of phototherapy
Light converts unconjugated bilirubin into water soluble pigment
154
Which type of bilirubinaemia can cause kernicterus?
Unconjugated bilirubinaemia
Fat soluble so can cross BBB
155
Kernicterus: which part of the brain is affected?
Basal ganglia
156
Most common cause of SIDS
Hypoxia
157
4 risk factors for SIDS
Prone sleeping
Parental smoking
Bed sharing
Hyperthermia and head covering
Prematurity
158
Management of asymptomatic neonatal hypoglycaemia
Encourage normal feeding
Monitor blood glucose
159
Management of symptomatic neonatal hypoglycaemia
Admit to neonatal unit
IV 10% dextrose
160
Symptoms of neonatal hypoglycaemia
Jitteriness
Seizures
161
Management of asymptomatic neonatal hypoglycaemia < 1mmol/L
Admit to neonatal unit
IV 10% dextrose
162
Risk factors for neonatal hypoglycaemia
Preterm
Maternal DM
IUGR
Hypothermia
Neonatal sepsis
163
Cleft lip pathophysiology
Failure of fronto-nasal and maxillary processes to fuse
164
Cleft palate pathophysiology
Failure of palatine processes and nasal septum to fuse
165
Blueberry muffin rash association
TORCH infection
Mum with recent flu
166
Management of ITP
Depends on symptoms. Doesn't need to be treated.
Otherwise:
1st: Steroids
2nd: IV IG
3rd: Rituximab
167
Pathophysiology of HbS formation
Substitution of Glu with Val in B chain
HbS polymerises to form sickle shaped cells
168
FBC findings for sickle cell anaemia
Low Hb
High reticulocyte count
169
Sickle cell anaemia management
Folic acid supplementation
Prophylactic hydroxyurea/hydroxycarbamide - increased HbF levels - prevents painful episodes or blood transfusion
Bone marrow transplant - if severe disease
170
Mechanism of hydroxycarbamide
Increases HbF levels
171
Management of vaso-occlusive crisis in SCD
IV fluids and analgesia
172
Acute complications seen in SCD
Acute chest syndrome
Splenic sequestration crisis
Vaso-occlusive/thrombotic/painful crisis
Aplastic crisis
Haemolytic
173
Features of vaso-occlusive crisis
Precipitated by infection, dehydration, deoxygenation
174
Features of sequestration crisis
Sickling within organs - splenomegaly
Increased reticulocyte count
175
Presentation of acute chest syndrome
Dyspnoea
Chest pain
Pulmonary infiltrate on CXR
176
Features of aplastic crisis
Parvovirus infection
Fall in Hb
Reduced reticulocyte count - bone marrow suppression
177
Blood film appearance in sickle cell trait
Normal
178
Blood film appearance in SCD
Sickled cells
Howell-Jolly bodies
179
Diagnostic investigation SCD
Haemoglobin electrophoresis
180
% chance of 2 carriers of sickle cell gene having unaffected offspring
75%=
25% unaffected
+
50% sickle cell trait
181
Most common bleeding disorder
Von Willebrand disease
182
Most common clotting disorder
Factor V Leiden
183
Haemophilia clotting results
Prolonged PTT
Low factor 8/9 and normal vWF
Normal PT and platelet
Normal bleeding time
184
Haemophilia mode of inheritance
X-linked recessive
185
Von Willeband disease mode of inheritance
Autosomal dominant
186
Fanconi anaemia mode of inheritance
Autosomal recessive
187
Fanconi anaemia features
Most common cause of inherited aplastic anaemia
Café au lait spots
Short stature
Thumb/radius abnormalities
188
Non-immune causes of hydrops foetalis
Severe anaemia e.g. parvovirus B19, alpha thalassaemia major, haemorrhage
Twin-to-twin transfusion syndrome
Infections e.g. CMV, rubella, VZV
Chorioangioma
Cardiac abnormalities
189
Immune causes of hydrops foetalis
Blood group incompatility - haemolytic disease of newborn
190
Beta thalassaemia mode of inheritance
Autosomal recessive
191
3 subtypes of beta thalassaemia
Beta thalassaemia minor – 1 gene inherited of reduced/absent beta chains – heterozygote
Beta thalassaemia intermedia – 2 genes inherited of reduced beta chains
Beta thalassaemia major – 2 genes inherited for absent beta chains (beta 0) – homozygote
192
Medical management options for constipation
1st: Osmotic laxative e.g. Movicol/macrogol
2nd: Stimulant laxative e.g. Senna
3rd: Alternative osmotic laxative e.g. Lactulose
193
Management of gastroenteritis
Oral rehydration solution
Admit if severely dehydrated
194
Management of gastro-oesophageal reflux
Advice regarding feeds
Trial thickened formula
2 week trial alginate therapy e.g. Gaviscon
4 week trial omeprazole suspension if:
Unexplained feeding difficulties
Distressed behaviour
Faltering growth
195
Surgical procedure for GORD
Nissen fundoplication
196
Meckel's diverticulum presentation
Usually asymptomatic
Severe rectal bleeding
Intestinal obstruction: volvulus/intussusception
197
Meckel's diverticulum: investigation if haemodynamically stable
Technetium scan
198
Meckel's diverticulum: investigation if haemodynamically unstable
Mesenteric arteriography
199
Meckel's diverticulum surgical procedure
Wedge excision or small bowel resection
200
Cow's milk protein allergy management
Specialised formula feeds - extensively hydrolysed
201
Cow's milk protein allergy: differentiating IgE and non-IgE mediated
IgE mediated can be tested immediately with skin prick test as reacts immediately
Non-IgE is delayed
202
Why is it advised that infants do not drink cow milk before age 1?
Risk of iron deficiency anaemia
203
CMPA prognosis
55% with IgE mediated can drink cow's milk by 5 years old
204
Which type of hyperbilirubinaemia is seen in biliary atresia?
Conjugated bilirubinaemia
205
Biliary atresia management
Surgery: Kasai procedure (hepatoportoeterostomy)
Nutrition and vitamin supplementation
Liver transplant if surgery fails or late presentation
206
Diagnostic investigation for biliary atresia
Cholangiography/ERCP
207
Biliary atresia presentation
Neonatal jaundice
Hepatomegaly and splenomegaly
Dark urine and pale stools
208
First line imaging for biliary atresia
Ultrasound visualises fibrosis of biliary system
209
Duodenal atresia presentation
Bilious vomiting from birth
210
Definitive treatment of duodenal atresia
Duodenoduodenostomy
211
Duodnela atresia Xray findings
'Double bubble' sign
212
Duodenal atresia associated conditions
Down syndrome
213
Pathophysiology of duodenal atresia
During 5th and 6th week of foetal development, duodenum is a solid cord
Apoptosis of cells in the centre of the solid cord leads to formation of normal cavity (lumen) of the duodenum - failure of process leads to duodenal atresia
214
Blind-ending oesophagus epidemiology
Oesophageal atresia alone - 10%
85% have blind proximal oesophagus with distal oesophagus having fistula with trachea
5% have fistulae in both proximal and distal oesophagus
215
Oesophageal atresia presentation
Polyhydramnios
Postnatal:
Respiratory distress
Drooling
Choking/swallowing problems
Distended abdomen
216
Oesophageal atresia investigation
NG tube + CXR - NG tube inserted until it can’t go further and Xray is taken
217
Management of oesophageal atresia
Surgical correction
218
Most common site of intussusception
Ileocecal site
219
Intussusception presentation
Sausage-shaped mass in abdomen
Redcurrant jelly stool
Abdominal distension
Shock
220
Intussusception management
IV fluids
1st: Rectal air insufflation
2nd: Surgical reduction
221
Intussusception investigations
USS: target sign
Concentric echogenic and hypogenic bands
222
% of children requiring surgical reduction of intussusception
25%
223
Giardiasis mangement
3 days metronidazole
224
Giardiasis diagnostic criteria
Cysts in stool and motile forms in small intestine
225
Coeliac disease presentation
Wasting of buttocks
Steatorrhoea (difficult to flush)
Dermatitis herpetiformis
226
Coeliac disease investigations
TTG
Anti-endomysial and anti-gliadin antibodies
Gold: Small bowel biopsy from duodenum/jejunum
227
Hirschsprung’s disease presentation
Neonates
Constipation
Delayed passage of meconium (after 48 hours)
Bilious vomiting
Lethargy & dehydration
Distended abdomen
228
Hirschsprung's disease investigations
AXR – dilated colon
Gold standard: rectal suction biopsy – shows lack of ganglionic nerves
229
Hirschsprung’s disease management
1st line: Rectal washouts/bowel irrigation
Gold standard: surgery to affected segment of colon
230
Hirschsprung’s disease surgical procedure
Swenson procedure
231
Hirschsprung’s disease associated disorders
Down's syndrome
Multiple endocrine neoplasia type IIa
232
Meconium ileus management
"Drip and suck" - IV fluids and stomach drainage
Surgery if severe
233
Meconium ileus investigation findings
AXR: bubbly appearance of intestines & lack of air-fluid levels
234
Pyloric stenosis metabolic + electrolyte abnormality
Metabolic alkalosis
Hyponatraemia, hypokalaemia & hypochloraemia
235
Pyloric stenosis management
NBM
IV fluids
Ramstedt pylorotomy
236
Pyloric stenosis presentation
Non-bilious, projectile vomiting after feeds
Visible gastric peristalsis
Weight loss
Palpable, olive shaped mass on abdomen
237
Pyloric stenosis investigations
Ultrasound - hypertrophy of pyloric sphincter
238
Antibiotic use associated with pyloric stenosis
Macrolides e.g. erythromycin
239
Malrotation presentation
Bilious vomiting
Abdominal pain
240
Malrotation associated conditions
Exomphalos
Diaphragmatic herniae
241
Malrotation management
Ladd's procedure - division of Ladd bands and widening base of mesentery
242
Congenital diaphragmatic herniae epidemiology
1 in 2000 newborns
50% survival rate
85% on left side
243
Congenital diaphragmatic hernia manifestations
Respiratory distress
Bowel sounds in respiratory exam
Scaphoid abdomen (concave)
Reduced breath sounds
244
Poor prognostic factor for congenital diaphragmatic hernia
Liver in thoracic cavity
245
Management of umbilical hernia
Large or symptomatic – repair at 2-3 years
Small and asymptomatic – repair at 4-5 years
246
Umbilical granuloma presentation
Overgrowth of red tissue – occurs during healing of umbilicus
Wet umbilicus, leaks clear/yellow fluid
247
Umbilical granuloma management
Add salt to wound – osmosis occurs – tissue necroses
248
Management of omphalitis
Topical + systemic steroids
249
Mesenteric adenitis presentation
Enlarged mesenteric lymph nodes with normal appendix
250
Risk associated with corticosteroid use in neonates < 8 days
Gastrointestinal perforation
251
Prematurity + developmental milestones
Adjust for gestational age until age 2 (40 weeks**)
252
Prematurity + immunisation schedule
Do not adjust for gestational age
253
Suckling reflex
Develops at 35 weeks
NG tube feeds before this
254
Surfactant production
Occurs between 24 - 28 weeks
255
Prematurity: management of apnoea and bradycardia
Nasal CPAP
Stimulation with caffeine
256
Why is there an increased risk of infection in premature infants?
Active IgG transfer occurs in last 3 months of pregnancy
257
Medical management of neonatal abstinence syndrome
Opiate: Oral morphine sulphate
Non-opiate: Oral phenobarbitone
258
Antibiotics given in preterm infants
IV BenPen + gentamicin
259
6 in 1 vaccine contents
DT, double P, double Hb
Diphtheria
Tetanus
Pertussis
Polio
HiB
Hep B
260
4 in 1 vaccine contents
Pre-school booster
Diptheria
Tetanus
Pertussis
Polio
261
3 in 1 vaccine contents
Teenage booster:
Tetanus
Diphtheria
Polio
262
3 inactivated vaccines
Rabies
Influenza
Polio
263
2 conjugated vaccines
HiB
PCV
264
Live attenuated vaccines
MMR
Rotavirus
Polio (inactivated in schedule)
BCG
Influenza (nasal) IM is inactivated
Typhoid
Yellow fever
265
Toixoid vaccines
Diphtheria
Tetanus
Pertussis
266
mRNA vaccines
Moderna
Pfizer
Encode spike protein
267
Vaccines given at 2 months
6 in 1
Men B
Rotavirus
268
Vaccines given at 3 months
6 in 1
PCV
Rotavirus
269
Vaccines given at 4 months
6 in 1
Men B
270
Vaccines given at 12-13 months
MMR
PCV
Men B
HiB / Men C
271
Vaccines given at 2-8 years old
Annual flu vaccine
272
Vaccines given at 3-4 years old
4 in 1 booster: diphtheria, tetanus, pertussis, polio
MMR
273
Vaccines given at 12-13 years old
HPV vaccination
274
Vaccines given at 13-18 years old
Men ACWY
3 in 1 booster: tetanus, diphtheria, polio
275
First sign of onset of puberty in boys
Testicular growth: > 4ml
