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Paediatrics Flashcards

1
Q

What is the first step of treatment in a child >5 with a confirmed diagnosis of asthma?

A

Very low dose ICS with short acting B2 agonist PRN

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2
Q

What is the first add on therapy for children >5 with a confirmed diagnosis of asthma?

A

Inhaled LABA

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3
Q

What is the 4th step of treatment in a child >5 with a confirmed diagnosis of asthma?

A

Increase ICS to medium dose and addition of SR theophylline

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4
Q

What is the first step of treatment in a child <5 with a confirmed diagnosis of asthma?

A

LTRA with short acting B2 agonist PRN

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5
Q

What are the characteristics of an acute severe asthma attack?

A
  • SpO2 <92%
  • PEF 33-50% of best or predicted
  • Can’t complete sentences in one breath or too breathless to talk or feed
  • Tachycardic
  • Respiratory rate >30bpm (>5 years) or >40 (1-5 years)
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6
Q

What are the characteristics of a life-threatening asthma attack?

A
  • SpO2 <92%
  • PER <33% of predicted
  • Silent chest
  • Cyanosis
  • Poor respiratory effort
  • Hypotension
  • Exhaustion
  • Confusion
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7
Q

In bronchiolitis what is the common age group and causative organism?

A
  • <2 years

* RSV

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8
Q

What are the symptoms of Bronchiolitis?

A
  • Coryzal symptoms
  • Dry cough
  • Difficulty feeding
  • Increasing breathlessness
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9
Q

What are the signs of Bronchiolitis?

A
  • Tachypnoea
  • Tachycardia
  • Hyperinflation of the chest
  • Fine end inspiratory crackles
  • Wheeze
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10
Q

What is the management of Bronchioloitis?

A

• Supportive
o Humidified oxygen via nasal cannula
o No evidence for steroids, abx or bronchodilators
• If severe full ventilatory support may be required

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11
Q

What is the commonest causative organism of Croup?

A

Parainfluenza virus

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12
Q

What are the signs and symptoms of Croup?

A

Symptoms:

  • Barking Cough
  • Fever
  • Hoarsness
  • Coryza

Signs:

  • Stridor
  • Chest recession
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13
Q

What is the management of Croup?

A
  • Supportive
  • Give Oral Dexamethasone or Prednisolone
  • If severe give nebulised adrenaline and oxygen by facemask
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14
Q

Colonisation by which organisms are common in CF?

A

Pseudomonas Auroginsoa and Burkholderia species

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15
Q

In neonates which group of organisms commonly cause pneumonia?

A

GBS and gram negative enterococci

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16
Q

In children over 5 years which group or organisms commonly cause pneumonia?

A

Mycoplasma pneumonia, streptoccocus pneumoniae and chlamydia pneumoniae

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17
Q

What signs would you see in a child with pneumonia?

A
  • Tachypnoea
  • Nasal flaring
  • Chest indrawing
  • End inspiratory coarse crackles
  • Decreased O2 sats
  • Dullness on percussion
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18
Q

Which antibiotics would you give in pneumonia for the following age groups:
Newborns?
>5 years?

A

Newborns: Gentamicin or broad spectrum cover

>5 years: Amoxicillin or oral macrolide, if more complicated give co-amoxiclav

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19
Q

What is respiratory distress syndrome? What are the risk factors?

A

Disease in neonates caused by a deficiency of surfactant

  • Common in <28 week prematurity
  • Boys > girls
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20
Q

What are the clinical features of respiratory distress syndrome?

A

Within 4 hours of birth:
o Tachypnoea >60 bpm
o Laboured breathing with chest wall recessions and nasal flaring
o Expiratory grunting to create positive airway pressure
o Cyanosis if severe
o Ground glass appearance on CXR

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21
Q

What is chronic lung disease of the newborn/bronchopulmonary dysplasia?

A

Infants who still require oxygen after 36 weeks of age

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22
Q

What are the complications of meconium aspiration?

A

o Mechanical obstruction
o Chemical pneumonitis
o Predisposition to infection
o The lung will often be overinflated with consolidation and can result in pneumothorax and pneumomediastinum

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23
Q

What are the diagnostic criteria for Neurofibromatosis type 1?

A

Two or more of the following:

  • Six or more café au lait spots >5mm in size before or 15mm in size after puberty
  • More than one neurofibroma, an unsightly firm nodular overgrowth of any nerve
  • Axillary freckles
  • Optic glioma
  • One lisch nodule
  • Bony lesions from sphenoid dysplasia
  • A first degree relative with NF1
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24
Q

What are the cutaneous and neurological features of tuberous sclerosis?

A

Cutaneous:

  • Depigmented ash leaf shaped patches which fluoresce under UV light
  • Roughened patches of skin usually over lumbar spine
  • Adenoma sebaceum in a butterfly distribution over he bridge of the nose and cheeks

Neurological:

  • Infantile spasms and developmental delay
  • Epilepsy that is often focal
  • Intellectual impairment
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25
Q

What are the causes of non communicating hydrocephalus?

A

Congenital Malformation

  • Aqueduct stenosis
  • Atresia of the outflow foramina of the fourth ventricle
  • Chiari malformation

Posterior fossa neoplasm or vascular malformation
Intraventricular haemorrhage in preterm infant

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26
Q

What are the causes of communicating hydrocephalus?

A
  • Subarachnoid haemorrhage

- Meningitis

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27
Q

What are the signs and symptoms of hydrocephalus in an older child?

A

Signs of raised ICP:

  • Headache
  • Vomiting
  • Altered level of consciousness
  • Back pain
  • Papilloedema
  • Low heart rate
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28
Q

What is the treatment of hydrocephalus?

A

Insertion of a ventriculoperitoneal shunt or endoscopic creation of a ventriculostomy

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29
Q

What is the common cause and clinical characteristics of an extradural haematoma?

A

Cause: Trauma

Clinical Characteristics: Lucid interval followed by deteriorating consciousness level with seizures, focal neurological signs, dilation of the ipsilateral pupil, paresis of contralateral limbs and false localising uni or bilateral VIth nerve palsy

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30
Q

What is the characteristic cause of subdural haematoma in children?

A

Non accidental injury caused by shaking or direct trauma

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31
Q

What is the inheritance pattern of Duchenne muscular dystrophy?

A

X linked recessive

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32
Q

What are the clinical features of Duchenne muscular dystrophy

What is the average age of diagnosis and life expectancy

A
  • Average age of diagnosis: 5.5 years
  • Presentation: waddling gait, language delay, climbing stairs 1 by 1 and slow run
  • Loss of ambulation around age 10-14
  • Respiratory failure or cardiomyopathy is usually the cause of death
  • Life expectancy: late 20s
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33
Q

How does Beckers muscular dystrophy differ from Duchenne?

A

Some functional dystrophin is produced

Age of diagnosis is 11, loss of ambulation during late 20s and life expectancy is late 40s to normal.

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34
Q

What are the red flag headache symptoms?

A

Worse lying down or with coughing and straining

Wakes up the child (different from headache on awakening)

Associated confusion and/or persistent nausea and vomiting

Recent change in personality, behaviour or educational performance

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35
Q

What are the features of a migraine without aura?

A
  • May last 1-72 hours
  • Commonly bilateral
  • Pulsatile over the temporal or frontal area
  • Accompanied by GI disturbance such as nausea,
    vomiting and abdominal pain
  • Photophobia and phonophobia common
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36
Q

What are febrile seizures and what age range do they occur in?

A

6months-5 years

Brief usually tonic clonic seizure accompanied by fever not caused by meningitis or encephalitis

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37
Q

What are the different types of generalised epileptic seizure?

A

Absence – Transient loss of consciousness with abrupt onset and termination

Myoclonic – Brief, often repetitive, jerking movements of the limbs, neck or trunk

Tonic – Generalised increase in tone

Tonic-clonic – Rhythmical contraction of muscle groups following the tonic phase. Followed by unconsciousness or deep sleep for up to several hours

Atonic – loss of muscle tone

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38
Q

What are the different types of focal epileptic seizure?

A

Frontal Seizures – motor phenomenon

Temporal lobe seizures – auditory or sensory (smell or taste) phenomena

Occipital – positive or negative visual phenomena

Parietal lobe seizures – contralateral altered sensation

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39
Q

How do you diagnose epilepsy in children?

A

Primarily based on detailed history ideally supported by video of the seizure

Focus should be given to particular triggers and any impairments the child may have

Examination should look for signs of neurocutaneous syndrome or neurological disorder

An EEG is indicated but rarely diagnostic

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40
Q

How do you manage epilepsy in children?

A

MDT Approach

Anti-epileptic therapies primarily based on the epileptic syndrome

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41
Q

What is an infantile spasm?

A

An epilepsy syndrome, presenting in infancy with varying aetiology. It usually presents in clusters and is characteristic of West’s Syndrome

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42
Q

What is the commonest type of paediatric brain tumour?

A

Astrocytoma occurs in 40% of children

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43
Q

What is the commonest type of cerebral palsy and what are the characteristics?

A

Spastic CP – 90% of cases

Damage to the UMN pathway that results in increased tone and reflexes. Can also result in hemiplegia, quadriplegia or diplegia

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44
Q

What is the characteristic presentation of cerebral palsy?

A

Abnormal limb or trunk posture and tone with delayed motor milestones

Feeding difficulties

Abnormal gait

Asymmetric hand function before hand-dominance develops

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45
Q

What are the clinical manifestations of mild HIE?

A

The infant is irritable, responds excessively to stimulation, may have staring of the eyes and hyperventilation and has impaired feeding

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46
Q

What are the clinical manifestations of moderate HIE?

A

The infant shows marked abnormalities of tone and movement, cannot feed and may have seizures

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47
Q

What are the clinical manifestations of severe HIE?

A

No normal spontaneous movements or response to pain

Tone in limbs may fluctuate between hypotonia and hypertonia

Seizures are prolonged and often refractory to treatment

Multi-organ failure

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48
Q

What is the management of HIE?

A

Prompt resuscitation

EEG to monitor for encephalitis or seizures

Anticonvulsants if seizures are present

Management of hypotension and hypoglycamia

Cooling to 33-34 degrees within 6 hours for 72 hours

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49
Q

What are the causes of acute nephritis?

A

Post infectious (Including streptococcus)
Vasclilitis (HSP, SLE etc.)
IgA nephropathy
Anti-glomerular basement membrane disease

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50
Q

What are the clinical features of stage 4 and 5 CKD?

A 
o	Anorexia and lethargy 
o	Polydipsia and polyuria 
o	Faltering growth 
o	Bony deformities 
o	Hypertension 
o	Acute on chronic renal failure 
o	Incidental finding or proteinuria 
o	Unexplained normochromic, normocytic anaemia
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51
Q

What is the most common cause of secondary or onset enuresis?

A

Emotional upset

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52
Q

What is the triad of haemolytic uraemic syndrome?

A

Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia

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53
Q

What are the signs and symptoms of Henoch-Schönlein Purpura?

A

Signs:
Fever
Rash on buttocks and extensor surfaces
Haematuria

Symptoms:
Abdominal pain
Joint pain

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54
Q

How long should a patient with Henoch-Schönlein Purpura be followed up for?

A

At least 6 months to ensure that there is no deterioration in renal function

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55
Q

What is the pathophysiology of nephrotic syndrome?

A

Heavy proteinuria leading to a low plasma albumin and oedema

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56
Q

What are the clinical features of nephrotic syndrome?

A

Periorbital oedema
Scrotal, vulval, leg and ankle oedema
Ascites
Breathlessness due to pleural effusions and abdominal distension
Infection such as periotnitis, septic arthritis, or sepsis due to loss of protective immunoglobulins in the urine

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57
Q

What are the characteristic features of sebhorrhaeic dermatitis?

A

In children <2 months:

  • Erythematous scaly eruption on the scalp
  • Scales form a thick yellow adherent layer called cradle cap
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58
Q

What are the spontaneously resolving rashes present in neonates?

A
  • Milia
  • Erythema Toxicum
  • Mongolian blue spots
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59
Q

What factors are deficient in haemophillia A and B?

A

A - FVIII

B - FIX

60
Q

What are the two most common leukaemias in children?

A

ALL

AML

61
Q

What are the clinical features of hodgkin lymphoma?

A

Painless lymphadenopathy - usually on the neck

B symptoms are rare

62
Q

What are the clinical features of sickle cell disease?

A 
Anaemia
Increased susceptibility to infection
Vaso-oclusive crises 
Priapism 
Splenomegaly
63
Q

What is the treatment of an acute crisis of sickle cell disease

A

Admission to hospital
Oral or IV analgesia
Hydration
If acute chest syndrome, stroke or priapsim consider exchange transfusion

64
Q

What is the epidemiology and inheritance of hereditary spherocytosis and G6PD deficiency?

A

HS: 1 in 5000, autosomal dominant, mostly caucasians

G6PD: High prevalence in central african, medittereanean and far eastern populations. X-linke.

65
Q

What are the clinical features of juvenile idiopathic arthritis?

A

Peristent joint swelling > 6 weeks
Stiffness after periods of rest
Morning joint pain

66
Q

What is the first line management of juvenile idiopathic arthritis?

A

Ensure management by a paediatric rheumatological MDT
NSAIDs and Analgesia for symptomatic relief of pain
Methrotrexate

67
Q

What are the clinical features of osteomyelitis?

A

Markedly painful and immobile limb
Acute febrile illness
Swelling and intense pain over the site of infection

68
Q

What are the characteristics of reactive arthritis and the common causative infections?

A

Transient joint swelling of the ankles or knees (oligoarthritis)
Enteric organisms: salmonella, Shigella, Campylobacter

69
Q

What are the characteristics of slipped upper femoral epiphysis?

A

Displacement of the femoral epiphysis postero-inferiorly
Present with limp, hip pain
Most common in children aged 10-15

70
Q

What are the causes of limp in children?

A 
Avascular necrosis (aged 5-10)
Transient synovitis (aged 2-12, follows a viral infection)
Slipped upper femoral epiphysis (aged 10-15)
71
Q

What are the characteristics and examples of a left to right cardiac shunt?

A

Breathless or asymptomatic

Examples: ASD, VSD, PDA

72
Q

What are the characteristics and some examples of Right to left cardiac shunts?

A

Blue

Tetralogy of Fallot, Transposition of the great arteries

73
Q

What are the causes of cardiac failure in Neonates, Infants and Older children?

A 
Neonates:
(Obstructed systemic circulation)
- Critical aortic valve stenosis
- Severe coarctation of the aorta
- Interruption of the aortic arch 
Infants: 
(High pulmonary blood flow)
- VSD
- AVSD
- Large persistent ductus arteriosus 
Older Children:
(Right or left heart failure)
- Eisenmenger's syndrome 
- Rheumatic heart disease
- Cardiomyopathy
74
Q

What are the clinical features of heart failure in children?

A

Symptoms:

  • Breathlessness
  • Sweating
  • Poor Feeding
  • Recurrent chest infections

Signs:

  • Poor weight gain
  • Tachypnoea
  • Tachycardia
  • Heart Murmur
  • Enlarged heart
  • Hepatomegaly
  • Cool peripheries
75
Q

What are the clinical features of Atrial Septal Defects?

A

Symptoms:

  • Commonly asymptomatic
  • Recurrent chest infections
  • Arrythmias from the 4th decade of life

Signs:

  • Ejection systolic murmur loudest at left sternal edge
  • Fixed and widely split second heart sound
76
Q

What is the mangement of an atrial septal defect?

A

Cardiac catherterisation and insertion of occlusion device if ASD is significant

77
Q

What are the clinical features of a small ventricular septal defect?

A
  • Up to 3 mm in diameter
  • Asymptomatic
  • Loud pansystolic murmur at lower left sternal edge
  • Spontaenous resolution
78
Q

What are the clinical features of a large ventricular septal defect?

A
  • Greater than 3 mm in diameter

Symptoms:

  • Heart failure with breathlessness and faltering growth after 1 week of age
  • Recurrent chest infections

Signs:

  • Tachnpnoea, Tachycardia
  • Hepatomegaly
79
Q

What is the management of a large ventricular septal defect?

A
  1. Heart failure drug therapy - Diuretics + Captopril
  2. Maintain adequate calorie intake
  3. Surgery at 3-6 months of age
80
Q

What are the 4 features of tetralogy of fallot

A
  • Large VSD
  • Overriding of the aorta
  • Pulmonary stenosis
  • Right ventricular hypertrophy
81
Q

What is the management of ToF?

A
  • Initially medical until definitive surgical management at 6 months: Closure of the VSD and relief of right ventricular outflow obstruction

Hypercyanotic cells should be managed as follows:

  • Sedation and pain relief
  • IV propranolol
  • IV fluid
  • Bicarbonate
  • Muscle paralysis and artificial ventilation
82
Q

What is the management of paediatric acne?

A
  • Maintian good hygeine
  • Topical treatments, sunshine, topical antibiotic and topical retinoids can be useful
  • In severe acne consider antibiotic therapy with tetracyclines or oral isotretinoin
83
Q

What is the management of paediatric eczema?

A
  • Avoidance of irritants and precipitants
  • Emmollients
  • Topical Corticosteroids
  • Immunomodulators when corticosteroids have proven innaffective
  • Occlusive bandages to prevent excessive itching and lichenification
  • Psychosocial support if needed
84
Q

What are common causes of erythema multiforme?

A
  • HSV
  • Mycoplasma pneumoniae
  • Other infections
  • Drug reactions
  • Idiopathic
85
Q

What are causes of erythema nodosum?

A
  • Streptoccocal infection
  • Primary TB
  • IBD
  • Drug Reactions
  • Idiopathic
86
Q

What is Steven-Johnson Syndrome?

A

Severe bullous form of erythema multiformed that invloves the mucus membrane. Is characterised by detachment of the epidermis from the dermis.

Causes:

  • Infection
  • Vaccination
  • Drug Reactions
87
Q

What is the management of Steven-Johnson syndrome?

A
  • Requires specialist burns unit support
  • Remove the cause
  • Dress with topical antibacterial agents
  • Fluid and pain management
88
Q

What is the triad of symptoms in Autism?

A
  • Impaired social interaction
  • Delayed speech and language
  • Imposition of routines with ritualistic behaviours
89
Q

A 13 kg child presents with shock. How would you administer fluids in this child?

A

Initial fluid resuscitation with 0.9% saline @ 20ml/kg therefore 260mls of fluid.

Then over 24 hours rehydration therapy + maintenance fluids:

Shock ~ 10% dehydration therefore 10% of 1300gms = 130mls/kg rehydration

Normal maintenance = 100mls/kg for the first 10k kg of weight + 50mls/kg for the next 10kg of weight

Therefore: 1150mls

Total Fluids in 24 hours: 2840ml
= 118mls/hour

90
Q

A 22 kg child presents with DKA causing shock. How would you manage this patient?

pH = 7.0

A

ABC Approach

As in shock you need initial fluid bolus however in DKA you give 10ml/kg therefore in this child a bolus of:
220ml

Next establish severity of DKA - pH is <7.1 therefore it is classed as severe and you correct for 10% dehydration: 2200mls

Give maintenance at reduced volumes as in DKA high volumes can cause cerebral oedema, in a 22kg child give 1ml/kg/hour therefore: 22ml/hour

2200/24 = 91
+ 22
= 113ml/hour

Give maintenance and rehydration fluids as 0.9% sodium chloride with additional 20mmol pottassium chloride per 500ml until glucose is <14mmol then give normal saline

1 hour after initiation of fluids give insulin infusion

91
Q

What is the management of anaphylaxis?

A
  1. ABCDE Approach (Likely to see swelling and hoarsness of airway, tachypnoea, wheeze and a pale clammy child)
  2. IM 1:1000 Adrenaline - repeat if needed after 5 minutes
  3. Establish a stable airway, give high flow oxygen
  4. Fluid resuscitation
  5. IM Chlorpheniramine
  6. IM Hydrocortisone
  7. Consider salbutamol
92
Q

What is the management of status epilepticus?

A

-ABCDE Approach

0 Mins - Maintain Airway, give high flow oxygen and check glucose

5 mins - If possible obtain vascular access and give IV/IO lorazepam or Buccal midazolam

15 Mins - IV/IO lorazepam and call for senior help. Prepare phenytoin

25 mins - Senior help is needed. Seek ICU advice. Give phenytoin IV/IO over 20 minutes. Anaethetist must be present at this stage

45 mins - Rapid sequence induction of anaesthesia with thiopental

93
Q

What are the clinical features of diabetes?

A
  • Polydipsia
  • Polyuria
  • Weight loss
  • Secondary enuresis
  • Skin Sepsis
  • Candida Infections
94
Q

What are the clinical features of a DKA?

A
  • Acetone smell on breath
  • Vomiting
  • Dehyrdration
  • Abdominal Pain
  • Hyperventilation
  • Hypovolaemic shock
  • Drowsiness
  • Coma
95
Q

What are the clinical features of congenital hypothyroidism?

A

Usually asymptomatic and picked up on screening but if missed:

  • Faltering growth
  • Feeding problems
  • Prolonged jaundice
  • Constipation
  • Pale, cold, mottled, dry skin
  • Coarse face
  • Large tongue
  • Goitre
  • Umbilical hernia
  • Delayed development
96
Q

What are the biochemical features of congenital adrenal hperplasia?

A
  • High levels of 17alpha-hydroxy-progesterone
  • Low Na
  • High K
  • Metabolic Acidosis
  • Hypoglycaemia
97
Q

What are the clinical features of congenital adrenal hyperplasia?

A
  • Virilisation of external genitalia in female infants with clitoral hypertrophy and variable fusion of the labia
  • Enlarged penis and pigmented scrotum in males
  • Salt loosing adrenal crisis presenting with vomiting, weight loss, hypotonia and circulatory collapse
  • Tall Stature
98
Q

What is the management of congenital adrenal hyperplasia?

A
  • Females may require corrective surgery to their genitalia
  • Lifelong glucocorticoids to suppress ACTH
  • Mineralocorticoids in event of salt loss
  • Monitoring of grwoth, skeletal maturity and plasma androgens
  • Additional hormone replacement to cover illness or surgery
99
Q

What are the categories of precocious puberty?

A
  • Gonadotrophin dependent - Premature activation of the hypothalamic-pituitary-gonadal axis. Sequence of pubertal development will be normal (cosonant)
  • Gonadotrophin independent - Excess sex steroids outside the pituitary gland. The sequence of pubertal development will be abnormal (dissonant)
100
Q

What is the management of precocious puberty?

A
  • Management is directed towards identifying and treating any underlying pathology
  • In girls treatment is sometimes required to delay menarche (this is important as this is the point at which growth is capped) - this treatment is with gonadotrophin releasing hormone analouges
101
Q

What is biliary atresia?

A

Progressive fibrosis and obliteration of the extrahepatic and intrahepatic biliary tree. Without intervention chronic liver failure will develop and death will occur within 2 years.

102
Q

What are the clinical features of biliary atresia?

A
  • Mild jaundice and pale stools
  • Normal birthweight followed by faltering growth
  • Hepatomegaly is present initially
  • Splenomegaly develops due to portal hypertension
103
Q

What is the management of biliary atresia?

A
  • Palliative surgery with a Kasai hepatoportoenterostomy which bypasses the fibrosed ducts and allows drainage of bile
  • Early surgery will increase the success rate
  • Nutritional supplementation is essential
  • If the surgery fails liver transplantation is indicated
  • Disease will eventually progress to cholangitis, cirrhosis and portal hypertension
104
Q

What are the clinical features of Coeliac disease?

A
  • Failure to thrive
  • Abdominal distension
  • Non specific abdominal symptoms
  • Mild anaemia
  • Abnormal stools
105
Q

What investigations are indicated in Coeliac disease?

A
  • Tissue transglutaminase test
    (this is not necessarily specific or sensitive enough for diagnosis)
  • Mucosal biopsy - this is the diagnostic test
106
Q

What is the management of constipation in children?

A

-Ensure adequeate oral fluid intake and good toileting habits

Mild:

  • Consider laxative such as movicol (polyethylene glycol 3350) +/- a stimulant laxative such as senna
  • If good response then continue movicol for a minimum of 6 months with titration of dose to ensure regualar stools

Impaction:
- Disimpaction regime of movicol (1-2 weeks of escalating dose)

107
Q

What is the management of GORD in children?

A

Uncomplicated:
- Excellent prognosis and can be managed purely through parental reassurance and alterin the size and consistency of feeds

Significant GORD:

  • Omeprazole
  • Ranitidine

Unresponsive GORD:
- Surgical management (Nissen Fundoplication)

108
Q

What is Hirchsprung disease and what are the clinical features?

A

Absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel

Clinical Features:

  • Presentation usually in the neonatal period with failure to pass meconium within the first 24 hours
  • Abdominal distension
  • Bile stained vomit
  • DRE may reveal a narrowed segment of bowel and on removal of the figner there will be a release of liquid stool
109
Q

What is the management of Hirschsprung Disease?

A

Surgery - Colostomy and anastomoses of innervated colon to the anus

110
Q

What are the clinical features of intussusception?

A
  • Paroxysmal, severe colicky pain with pallor
  • Refusal of feeds
  • Bile stained vomit
  • Sausage shaped mass
  • Passage of reduccrant jelly stool
  • Abdominal distension and shock
111
Q

What is the management of intussusception?

A
  • IV fluid resuscitation as required
  • If no signs of peritonitis then rectal air insufflation is 75% successful
  • Remaining 25% require surgery
112
Q

How will Hepatitis B serology demonstrate: Acute infection, Chronic infection and Immunisation?

A

Acute:

  • HB Core Antibody +
  • HB Surface Antigen +

Chronic:

  • HB Core antibody +
  • HB Surface antigen +

Immunisation
- HB Surface antibody +

113
Q

What are the clinical features of a viral hepatitis?

A
  • Nausea
  • Vomiting
  • Abdominal Pain
  • Lethargy
  • Jaundice
114
Q

What are the clinical features of acute liver failure?

A
  • Jaundice
  • Encephalopathy (Irritability, confusion, drowsiness, aggression)
  • Coagulopathy
  • Hypoglycaemia
  • Electrolyte disturbance
115
Q

What is the management of Aute liver failure?

A

-Early referral to paediatric liver centre

Stabilisation:

  • IV Dextrose to maintaine blood glucose
  • Prophylactic antibiotics and antifungal agents
  • Prevention of haemorrhage with Vitamin K
  • Prevention of cerebral oedema with fluid restriction and mannitol diuresis if required
116
Q

What are the clinical features of necrotizing enterocolitis?

A
  • Feed intolerance
  • Vomiting
  • Abdominal Distension
  • Fresh blood in stool
  • Can present with shock
117
Q

What is the management of NEC?

A
  • Stop oral feeds
  • Broad spectrum antibiotics
  • Parenteral nutrition
  • Mechanical ventilation and circulatory support as required
  • Surgery indicated if bowel perforation present
118
Q

What are the causes of jaundice within the first 24 hours of life?

A
  • Haemolysis (unconjugated bilirubin) - Rhesus haemolytic disease, ABO incompatibility, G6PD deficiency, spherocytosis
  • Can also be caused by congenital infection (conjugated bilirubin)
119
Q

What are the causes of jaundice between 24 hours and 14 days of life?

A
  • Physiological jaundice
  • Breast milk jaundice
  • Dehydration
  • Infection
120
Q

What are the causes of jaundice after 14 days of life?

A
  • Biliary Atresia (IMPORTANT TO RULE OUT)
  • Breast milk jaundice
  • Infection
  • Congeintal hypothyroidism
121
Q

What is Kernicterus (neonatal jaundice)

A
  • Encephalopathy resulting from deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei
  • Can occur when the level of unconjugated bilirubin exceeds the albumin binding capacity of bilirubin in the blood
  • Neurotoxic effects vary in severity
  • Symptoms include: Irritability, hypertonia, seizures and coma
122
Q

How do you mangae neonatal jaundice?

A
  • Phototherapy (converts unconjugated bilirubin into a harmless water soluble pigment that is then excreted in urine
  • Exchange transfusion
123
Q

What are the clinicla features of pyloric stenosis?

A
  • Vomiting with increasing frequency and forcefulness overtime until it becomes projectile
  • Hunger post vomiting until dehydration leads to a lack of interest in feeding
  • Weight loss
  • Hypochloraemic metabolic acidosis
124
Q

How do you treat pyloric stenosis?

A
  • Correction of fluid and electrolyte imbalances with IV fluids
  • Definitive treatment is pyloromyotomy (feeds can be reinitatied within 6 houts and discharge is at 2 days)
125
Q

What are the clinicla features of Patau’s Syndrome (Trisomy 13)

A
  • Structural defect of the brain
  • Scalp Defects
  • Small Eyes and other eye defects
  • Cleft lip and palate
  • Polydactyly
  • Cardiac and renal malformations
126
Q

What are the clinical features of Edward’s Syndrome (Trisomy 18)

A
  • Low birthweight
  • Prominent occiput
  • Small mouth and chin
  • Short sternum
  • Flexed, overlapping fingers
  • Rocker-bottom feet
  • Cardiac and renal malformations
127
Q

What are the clinical features of Down’s Syndrome (Trisomy 21)

A
  • Round face and flat nasal bridge
  • Up slanted palpebral fissures
  • Epicanthic folds
  • Brushfield sports in iris
  • Small mouth an dprotruding tongue
  • Small ears
  • Flat occiput and third fontanelle
  • Short neck
  • Single palmar creases
  • Hypotonia
  • Congenital heart defects
  • Duodenal atresia
  • Hirchsprung disease
128
Q

What are the clinical features of Noonan Syndrome?

A
  • Deep groove in philtrum
  • Widely spaced eyes that are usually pale blue or blue green
    Low set ears that are rotated backwards
  • High arched palate
  • Small lower jaw
  • Short neck
  • Neck Webbing
  • Occasional mild learning difficulties
  • Pectus excavatum
  • Short stature
  • Congenital heart diease (PS, ASD)
129
Q

What are the clinical features of Prader-Willi Syndrome

A
  • Narrow forehead
  • Almond shaped eyes
  • Triangular mouth
  • Hypotonia
  • Neonatal feeding difficulties
  • Faltering growth in infancy
  • Obesity
  • Hypogonadism
  • Developmental delay
  • Learning Difficulties
130
Q

What are the clinical features of Turner Syndrome (45 X)?

A
  • Lymphoedema of hands and feet in neonate which can eprsit
  • Spoon shaped nails
  • Short stature
  • Neck webbing or thick neck
  • Wide carrying angle
  • Widely spaced nipples
  • Coarctation of the aorta
  • Delayed puberty
  • Ovarian dysgenesis
  • Hypothyroidism
  • Renal anomalies
  • Pigmented moles
131
Q

What are the clinical features of Klinefelter Sundrome? (47XXY)

A
  • Infertility
  • Hypogonadism with small testes
  • Pubertal development will be normal
  • Gynaecomastia in adolescence
  • Tall stature
  • Intelligence in the normal range
132
Q

What are the commonest causative organisms of bacterial meningitis in Neonates and Older Children?

A

Neonates (think vaginal bacteria):

  • GBS
  • E-Coli
  • Listeria

Infants and Older:

  • Neisseria Meningitides
  • Haemophilus influenzae B
  • Streptococcus pneumoniae
133
Q

What are the clinical features of impetigo?

A
  • Erythematous macules –> vesicular or pustular lesions on the face, neck and hands
  • On ruptures of the lesions a characteristic honey coloured crusty lesion is produced
134
Q

What is the management of impetigo?

A
  • Topical Antibiotics (mild disease)
  • Oral antibiotics (more severe) - flucoxacillin has better efficacy but is poorly tolelrated, co-amoxiclav is better tolerated
  • Keep child off school until lesions are dry
135
Q

What are the clinical features of periorbital cellulitis?

A
  • Fever
  • Erythema and tenderness around the eye
  • Oedema around the eye
136
Q

What is the management of periorbital cellulitis?

A
  • High dose IV ceftriaxone to prevent posterior spread
137
Q

What are the types of infection seen in HSV infection?

A
  • Asymptomatic
  • Gingivostomatitis
  • Eczema herpeticum
  • Herpetic whilows
  • Eye disease
  • Disseminated
138
Q

What are the clinical features of an EBV infection?

A
  • Fever
  • Malaise
  • Tonsilitis
  • Lymphadenopathy
  • Petechiae on the soft palate
  • Splenomegaly and hepatomegaly
  • Maculopapular rash
  • Jaundice
139
Q

What are the clinical features of Measles?

A
  • Spread by droplets
  • Fever
  • Rash (maculopapular rash that becomes blotchy and confluent)
  • Koplik Spots (white spots on buccal mucosa
  • Conjunctivitis and coryza
  • Cough
140
Q

What are the clinical features of Mumps?

A
  • 15-24 day incubation period
  • Onset with fever, malaise and parotitis
  • Fever should resolve within 3-4 days
  • Generally mild and self limiting
141
Q

What are the clinical features of Kawasaki’s Disease?

A

CRASH AND BURN:

  • Conjunvtivitis
  • Rash
  • Adenopathy
  • Strawberry Tongue
  • Swollen erythematous hands
  • 5 days of fever
142
Q

What is the management of Kawasaki’s Disease?

A
  • Treatment with IV immunoglobulin

- Aspirin

143
Q

What are the clinical features of Malaria?

A
  • Fever
  • Diarrhoea
  • Vomiting
  • Flu like symptoms
  • Jaundice
  • Anaemia
  • Thrombocytopenia
144
Q

What is the treatment for active TB?

A

RIPE

  • Rifampacin, Isoniazid, Pyrazinamide and Ethambutol for 2 months
  • Rifampacin and Isoniazid for a further 4 months
145
Q

What are the clinical features of Fragile X syndrome?

A

In Males:

  • Learning difficulties
  • Large, low set ears, long thin face and high arched palate
  • Macroorchidism
  • Hypotonia
  • Autisim is more prevalent
  • Mitral valve prolapse

In Females
- Normal to mild symptoms

TP Specialties (3 decks)

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