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Fourth Year > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Symptoms of mild-moderate allergic reaction?

A
  • Angioedema (swelling of lips, face, eyes).
  • Itchy / tingling mouth.
  • Sudden change in behaviour.
  • Hives or itchy skin rash.
  • Abdominal pain or vomiting.
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2
Q

Signs of anaphylactic reaction?

A
  • Airway: swelling, hoarseness, stridor, difficulty swallowing.
  • Breathing: tachypnoea, wheeze, fatigue (use of accessory muscles or indrawing of intercostal muscles), cyanosis, SpO2 <92%, confusion.
  • Circulation: pale, clammy, hypotension, faint, drowsy, coma.
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3
Q

What does of adrenaline should be administered IM to a child over 12 in anaphylaxis?

A

500 micrograms (0.5mL - i.e. the same as an adult).

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4
Q

What dose of adrenaline should be administered IM to a child 6-12 years old who is in anaphylaxis?

A

300 micrograms (0.3mL).

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5
Q

What dose of adrenaline should be administered IM to a child less than 6 years old who is in anaphylaxis?

A

150 micrograms (0.15mL).

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6
Q

How would you fluid challenge a child after administering IM adrenaline for anaphylaxis?

A

IV crystalloid 20mL/kg.

If crystalloid is cause of anaphylaxis then stop the IV

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7
Q

What advice would you give to the parents of a child with a new diagnosis of asthma with regards to bathing?

A
  • Don’t use soap, bubble bath or shower gel.
  • Use an emollient soap substitute instead.
  • Minimise the amount of time shampoo spends in contact with skin.
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8
Q

Describe what an emollient is in layman’s terms.

A

Used to moisturise the skin, they can be used liberally and often - which is when they work best.

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9
Q

Explain how to use an emollient for eczema.

A
  1. wash hands prior to using.
  2. if using a tub without a dispenser - use a spoon to take it out the tub (reduces risk of infection).
  3. use 1-2x day applying in the direction of hair growth (downward) and avoiding rubbing back and forth.
  4. continue to use even when skin looks okay.
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10
Q

What warnings should you advise parents of when using emollients for eczema?

A

ointments containing white soft paraffin and emulsifying ointment are easily ignited - avoid flame and smoking and warn friends/ relatives to be careful.

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11
Q

What advice should you give to parents when using topical steroids for eczema?

A
  • Apply only on affected areas i.e. itchy, red, rough skin.
  • Use once daily and only when needed.
  • One fingertip unit (i.e. from finger top to first joint) is enough to cover an area the size of two adult hands.
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12
Q

Explain why steroids are used in eczema in layman’s terms.

A

Steroids act on affected areas to reduce the inflammation of the skin. They are safe when used correctly and benefits outweigh risks.

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13
Q

What is physical abuse?

A

Causing physical harm to a child or young person (e.g. hitting, shaking, burning, suffocating, poisoning, fabricating or inducing illness).

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14
Q

What is emotional abuse?

A

Persistent emotional neglect or ill treatment that has a severe and persistent adverse effect on a child’s emotional development.

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15
Q

What is sexual abuse?

A

Any act that involves the child in any activity for the sexual gratification of another person regardless of the child’s consent or assent.

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16
Q

What is neglect?

A

Persistent failure to meet a child’s basic physical and/or psychological needs - likely to result in serious impairment of the child’s health or development.

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17
Q

Name child-specific factors that make children more vulnerable to physical abuse?

A
  • First child in a family.
  • Unwanted pregnancy.
  • Male.
  • Disabled or congenital abnormality.
  • <2 years old.
  • History of neglect.
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18
Q

Name familial factors that make children more vulnerable to physical abuse?

A
  • Low socioeconomic status.
  • Family insecurity or instability.
  • Mental health problems in family.
  • Illicit drug abuse.
  • History of violence in family.
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19
Q

What investigations might be arranged to investigate non-accidental injury?

A
  • CT brain.
  • Skeletal survey.
  • Ophthalmology review to look for retinal haemorrhages.
  • Full clotting screen.
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20
Q

Who can report concerns to child protection?

A

ANYONE. You do not have to be certain but you are expected to explain why you are concerned.

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21
Q

How does a healthcare professional refer suspected abuse to child protection?

A

Usually by phone to the duty social worker and then follow up in writing.
If there is concern the child is in immediate danger, the police should be contacted.

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22
Q

If you suspect a child is in immediate danger, what should you do as a healthcare professional?

A

Contact police.

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23
Q

As a medical student, if you suspect physical abuse while on placement, what should you do?

A

Speak to supervisor and block supervisor.

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24
Q

As a medical student, if you suspect physical abuse while NOT on placement, what should you do?

A

Contact the public child protection line.

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25
Q

Which features of bruising would raise suspicion of non-accidental injury?

A
  • Child not yet independently mobile e.g. infants.
  • Multiple bruises in one area of similar size and shape (fingertip-gripping, blunt force trauma, crushing).
  • Bruises in the shape of a pattern or object.
  • Bruising of a soft, non-bony area e.g. abdomen, bum, back, soft parts of arms, thighs.
  • Head, ears, neck.
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26
Q

Bruising usually occurs as a result of?

A
  • Blunt force impact e.g. a blow.
  • Falling.
  • Crushing.
  • Pinching.
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27
Q

What kind of object would cause a tramline bruise?

A

Blunt, thin linear object e.g. mop handle, hairbrush handle, rod.

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28
Q

When does tramline bruising occur?

A
  • When a linear object hits the skin it causes blood vessels either side of the object to stretch, tear and leak blood.
  • The vessels underneath the object are compressed and so do not leak.
    > Linear bruising with an area of central clearing.
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29
Q

How do a burn and a scald differ?

A
  • Burn results from dry heat e.g. fire, iron, radiator.

- Scald results from wet heat e.g. hot oil, steam, boiling water.

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30
Q

Which tends to be more severe, burns or scalds?

A

Burns.
- Severity of which is measured by depth and extent.

Scalds tend to be less severe and often show blistering.

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31
Q

What features of a burn or a scald would raise suspicion of non-accidental injury?

A
  • Child not yet mobile.
  • On an area not normally coming into contact with hot objects e.g. dorsum of hands, feet, legs, buttock.
  • Shape or patterned e.g. cigarette burns.
  • Glove and stocking distribution on limbs or on buttocks, suggesting immersion scald.
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32
Q

Differentials for non-accidental injury?

A
  • Bleeding disorders: clotting screen.
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33
Q

An abrasion superimposed on a bruise is likely to have been caused by what?

A

A blow with or a fall onto a blunt object.

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34
Q

Which type of rib fractures are especially associated with non-accidental injury?

A

Posterior rib.

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35
Q

What is a skeletal survey?

A
  • Series of x-rays taken in a child with suspected NAI.
  • Designed to detect occult fractures.
  • Compulsory in suspected NAI of children <2 y/o.
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36
Q

What features of a skeletal survey would make you suspicious of NAI?

A
  • Rib fractures (especially posterior).
  • Metaphyseal corner fractures (bucket handle fracture - often caused by shaking).
  • Skull fracture (especially if non-parietal).
  • Any fractures in a non-mobile child.
  • Multiple fractures.
  • Fractures of different ages / stages of healing.
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37
Q

What is cradle cap?

A

Fungal infection in infants causing itching and scaling of the scalp.

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38
Q

When is a CT head indicated in suspected NIA?

A

Acute presentations if there are signs suggestive of intracranial injury or in infants <1 year old.

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39
Q

What is the “classic triad” of symptoms in a shaken child (NAI)?

A
  • Bilateral retinal haemorrhages.
  • Subdural haemorrhage.
  • Encephalopathy.
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40
Q

Signs of non accidental head injury?

A
  • Skull fracture.
  • Extradural haemorrhage.
  • Confusion and decreased consciousness.
  • Bilateral retinal haemorrhages.
  • Subdural haemorrhage.
  • Encephalopathy.
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41
Q

True or false? Short distance accidental falls are commonly associated with skull fracture and intracranial injury.

A

False.

  • Rarely cause skull fracture.
  • Even more rarely cause intracranial injury.
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42
Q

A fracture occurring as a result of a short distance accidental fall would have what features?

A

Simple and linear with no depression and confined to one bone.

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43
Q

When do abrasions occur?

A

When the skin is crushed or scraped.

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44
Q

What kind of injury would be associated with being dragged along the carpet?

A

Abrasion - tangential contact with the floor is likely to scrape off parts of the epidermis.

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45
Q

How can you tell from an abrasion, in which direction someone was being dragged?

A

The more severe part of the abrasion suggests this part was leading and the less severe part suggests this part was following - giving us direction.

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46
Q

The presence of an abrasion indicates what about the timescale?

A

It is likely to have occurred recently.

They are superficial, heal quickly and don’t scar

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47
Q

What is a crush abrasion?

A

Abrasions which may leave a pattern depicting the object used.

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48
Q

What is a scrape abrasion?

A

Abrasion leaving skin tags and lines showing the direction of the injury.

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49
Q

What features of abrasions would make you suspicious of NAI?

A
  • Presence on a non-mobile child.
  • Symmetrical.
  • On areas usually covered by clothing e.g. chest, back, axilla.
  • On areas unlikely to be hit during play e.g. ears, eyes.
  • Around ankles or wrists (e.g. possible ligature marks).
  • Patterns or shapes.
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50
Q

What is the normal resting heart rate in an infant <1 y/o?

A

110-160bpm.

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51
Q

What is the normal resting heart rate in an infant 1-2 y/o?

A

100-150bpm.

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52
Q

What is the normal resting heart rate in a child 2-5 y/o?

A

95-140bpm.

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53
Q

What is the normal resting heart rate in a child 5-12 y/o?

A

80-120bpm.

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54
Q

What is the normal resting heart rate in a child >12 y/o?

A

60-100bpm.

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55
Q

What is the normal respiratory rate in an infant <1 y/o?

A

30-40 / min.

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56
Q

What is the normal respiratory rate in an infant 1-2 y/o?

A

25-35 / min.

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57
Q

What is the normal respiratory rate in a child 2-5 y/o?

A

25-30 / min.

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58
Q

What is the normal respiratory rate in a child 5-12 y/o?

A

20-25 / min.

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59
Q

What is the normal respiratory rate in a child >12 y/o?

A

15-20 / min.

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60
Q

What is the normal systolic blood pressure (mmHg) in an infant <1 y/o?

A

70-90 mmHg.

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61
Q

What is the normal systolic blood pressure (mmHg) in an infant 1-2 y/o?

A

80-95 mmHg.

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62
Q

What is the normal systolic blood pressure (mmHg) in a child 2-5 y/o?

A

80-100 mmHg.

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63
Q

What is the normal systolic blood pressure (mmHg) in a child 5-12 y/o?

A

90-110 mmHg.

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64
Q

What is the normal systolic blood pressure (mmHg) in a child >12 y/o?

A

100-120 mmHg.

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65
Q

Describe the head of an infant.

A
  • Infants have a relatively large head (in comparison to their body) and a prominent occiput.
  • Large surface area compared to volume.
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66
Q

What is the blood volume of a child?

A

80ml/kg.

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67
Q

What is foetal haemoglobin (HbF)?

A

α2γ2 - main oxygen carrying protein in human foetus persisting in circulation until infant is around 2-4months old.

68
Q

Commonest cause of acute illness in children?

A

Sepsis.

69
Q

Although arrhythmias are rare in children, which is the most common?

A

Supraventricular tachycardia.

70
Q

Which signs indicate effortful breathing in a child?

A
  • Recession (intercostal).
  • High (or low) respiratory rate.
  • Accessory muscle use.
  • Nasal flare.
  • Inspiratory stridor, expiratory wheeze, grunting.
71
Q

How do you assess efficacy of breathing in a child?

A
  • Chest expansion.
  • Air entry.
  • Oxygen saturations.
72
Q

How do you assess effects of breathing (effort, efficacy, effects)?

A
  • Heart rate.
  • Skin colour.
  • Mental status.
73
Q

How do you assess circulatory signs of shock?

A
  • Pulse (rate and volume).
  • Capillary refill.
  • Blood pressure.
    HYPOTENSION IS A PRE-TERMINAL SIGN.
74
Q

How do you assess the effects of circulatory inadequacy?

A
  • Respiratory rate.
  • Skin temperature / colour.
  • Mental status.
75
Q

How do you assess potential central neurological failure?

A
  • Conscious level.
  • Pupils.
  • Posture (decorticate / decerebrate posturing).
76
Q

What does AVPU stand for?

A

Alert, Voice, Pain, Unresponsive.

77
Q

What are we assessing in exposure in an acutely ill child?

A
  • Temperature.
  • Rash.
  • Bruising.
78
Q

What congenital heart defect is associated with trisomy 21?

A
  • ventricular septal defect.

- atrial septal defect.

79
Q

What congenital heart defect is associated with trisomy 18 (Edwards)?

A
  • VSD.
  • Double outlet right ventricle (DORV).

(ventricular septal defect ALWAYS occurs with DORV).

80
Q

What other congenital heart defect always occurs in association with double outlet right ventricle (DORV)?

A
  • Ventricular septal defect.
81
Q

What congenital heart defect is associated with trisomy 13 (Patau)?

A
  • Ventricular septal defect.

- Double outlet right ventricle.

82
Q

What is double outlet right ventricle (DORV)?

A

Both the Great Arteries i.e. the aorta and the pulmonary artery originate from the RV (deoxygenated).

83
Q

What congenital heart defect is associated with Turner’s syndrome?

A

Coarctation of the aorta.

84
Q

What congenital heart defect is associated with DiGeorge syndrome?

A
  • Truncus arteriosus.
  • Interrupted aortic arch.
  • Tetralogy of fallot.
  • Ventricular septal defect.
85
Q

What is tetralogy of fallot?

A

Four congenital abnormalities:

  1. VSD.
  2. Pulmonary valve stenosis.
  3. Misplaced aorta.
  4. Right ventricular hypertrophy.
86
Q

Symptoms of cardiac disease in an infant?

A
  • Breathlessness.
  • Difficulty feeding or poor weight gain.
  • Sweating with feeding.
  • Cyanosis.
87
Q

Risk factors for cardiac disease in an infant?

A
  • Prematurity.

- Other anomalies or a syndrome (e.g. Trisomy 13 / 18 / 21, Turner’s, Di George).

88
Q

What is trisomy 13?

A

Patau

89
Q

What is trisomy 18?

A

Edwards

90
Q

What is the first heart sound?

A

Mitral and tricuspid valves.

91
Q

What is the second heart sound?

A

Aortic and pulmonary valves - typically split.

92
Q

What is acrocynaosis and is it pathological?

A

Acrocyanosis is blue hands and feet, potentially also perioral blueness.
- Common in young children - NOT a sign of cardiac disease.

93
Q

Describe the cyanosis associated with cyanotic heart disease?

A

Most cyanotic heart disease makes children blue all the time.

94
Q

Children can be intermittently cyanotic without cyanotic heart disease (e.g. acrocyanosis). Which feature would suggest tetralogy of fallot in addition to intermittent central cyanosis?

A
  • Murmur.
95
Q

What is a grade 1 murmur?

A

Faint murmur heard with concentration.

96
Q

What is a grade 2 murmur?

A

Faint murmur heard immediately.

97
Q

What is a grade 3 murmur?

A

Murmur easily heard immediately.

98
Q

What is a grade 4 murmur?

A

Murmur loud with palpable thrill.

99
Q

What is a grade 5 murmur?

A

Loud - heard with stethoscope just touching the chest and likely accompanied by a palpable thrill.

100
Q

What is a grade 6 murmur?

A

Extremely loud, heard with stethoscope off the chest.

101
Q

What findings would suggest an innocent paediatric murmur?

A
  • Short systolic.
  • Asymptomatic.
  • Soft i.e. Grade 3/6 or
102
Q

What findings would suggest a pathological paediatric murmur?

A
  • Diastolic or pansystolic murmur.
  • Symptomatic.
  • Palpable thrill.
  • Grade 4/6 or >.
103
Q

Cyanotic types of congenital heart disease?

A
  • Tetralogy of Fallot.

- Transposition of the Great Arteries.

104
Q

Acyanotic types of congenital heart disease?

A
  • VSD.
  • ASD.
  • Pulmonary stenosis.
  • PDA.
  • Aortic stenosis.
  • Coarctation of the aorta.
105
Q

The presence of cyanosis is suggestive of which congenital heart diseases?

A
  • Tetralogy of Fallot.
  • Transposition of the Great Arteries.
  • Pulmonary atresia with intact septum.
106
Q

Describe systemic duct-dependent lesions.

A
  • Severe obstruction of blood out of the left side of the heart.
  • Systemic circulation is therefore dependent on the PDA - which must remain open until palliative or curative procedure can be performed.
107
Q

Describe cyanotic duct-dependent lesions.

A
  • Obstruction to pulmonary blood flow OR lack of oxygenation of systemic blood.
  • Patient relies on PDA > keep duct open until adequate mixing is secured e.g. atrial septostomy.
108
Q

What is an atrial septal defect?

A

Oxygenated blood from left atrium shunts via defect into right atrium > enlargement of atria, RV and pulmonary artery.

109
Q

What is a ventricular septal defect?

A

Oxygenated blood from LV shunts via defect into RV (L>R) > enlargement of ventricles and pulmonary artery.
Also exposes the right ventricle and pulmonary arteries to abnormally high pressure.

110
Q

What are important causes of vomiting to consider in a child?

A
  • Infection e.g. meningitis.

- Surgical causes e.g. malrotation, pyloric stenosis.

111
Q

What features of vomiting in an infant would suggest a chronic rather than acute cause e.g. infection?

A
  • Present since birth.
112
Q

Features of Gastro-oesophageal reflux in an infant?

A
  • Frequent vomiting associated with discomfort (e.g. whining or uncomfortable during feeds or may draw legs up or arch back or cry).
  • Improvement of symptoms when in upright posture.
  • Gaining weight normally (if severe there may be poor weight gain).
  • No signs of dehydration.
  • Milky vomit.
113
Q

What other congenital defect occurs in association with oesophageal atresia (and vice versa)?

A

Tracheo-oesophageal fistula.

114
Q

Congenital anomalies of the foregut?

A
  • Oesophageal atresia.
  • Duodenal atresia.
  • Extrahepatic biliary atresia.
  • Annular pancreas.
115
Q

Congenital anomalies of the midgut?

A
  • Exomphalos.
  • Umbilical hernia.
  • Gastroschisis.
  • Malrotation.
  • Ileal diverticulum (Meckel’s diverticulum).
  • Stenosis, atresia and duplications.
116
Q

Congenital anomalies of the hindgut?

A
  • Imperforate anus.
  • Fistulae: rectum to urethra / bladder / vagina.
  • Hirschsprung’s disease.
117
Q

Oesophageal atresia and tracheo-oesophageal fistula may be associated with which chromosomal abnormalities?

A
  • Down’s syndrome ( Trisomy 21).
  • Edward’s syndrome (Trisomy 18).
  • VACTERL (vertebral, rectal, cardiac, tracheo-oesophageal, renal and limb (especially radial) anomalies - group often presenting together).
118
Q

Which antenatal finding may suggest a diagnosis of oesophageal atresia?

A
  • Polyhydramnios on antenatal ultrasound.
119
Q

What findings in a neonate may suggest oesophageal atresia or tracheo-oesophageal fistula?

A
  • Pooling of saliva in mouth.

- Choking or dusky episodes (cyanosis) when feeding > milk pours into lung.

120
Q

What finding in a child may suggest tracheo-oesophageal fistula?

A
  • Recurrent chest infections.

- i.e. isolated (without atresia) narrow “H-type” fistula.

121
Q

How is diagnosis of oesophaeal atresia made postnatally?

A
  • If an NG tube cannot be passed into the stomach.
  • No stomach bubble present on CXR in isolated atresia.
  • Presence of stomach bubble suggests distal tracheo-oesophageal fistula.
122
Q

How is diagnosis of an isolated tracheo-oesophageal fistula made?

A
  • Contrast swallow radiograph.
123
Q

How is tracheo-oesophageal fistula and oesophageal atresia managed?

A
  • Nil by mouth until reanastomosis surgery (usually within 24h).
  • Continuous suction of oropharynx to prevent saliva aspiration.
124
Q

What complications of oesophageal atresia / tracheo-oesophageal fistula commonly occur despite (or because of) management?

A
  • Gastro-oesophageal reflux.

- Strictures leading to dysphagia (surgical complication).

125
Q

What is the difference between gastroschisis and exomphalos?

A

Both are defects of the anterior abdominal wall that allow herniation of the bowel.

  • Gastroschisis: only intestine herniates, usually to the right of the umbilicus.
  • Exomphalos: intestine and or liver may herniate, but is covered by peritoneal membrane.
126
Q

What conditions are associated with gastroschisis?

A

Rarely associated with:

  • Cleft lip and palate.
  • Heart defects:
  • Intestinal atresia.
127
Q

Conditions associated with exomphalos?

A

Common (50%):

  • Beckman-Weidermann syndrome.
  • Trisomy 13, 18, 21.
128
Q

What is Hirschsprung’s disease?

A

Lack of parasympathetic innervation of the distal colon > constant contraction of affected bowel segment.

129
Q

What part of the bowel is always involved in Hirschsprung’s disease?

A
  • Internal anal sphincter.
130
Q

What causes Hirschsprung’s disease?

A

Failure of neural cells to migrate to the bowel muscle.

131
Q

Typical Hirschsprung presentation?

A
  • Newborn fails to pass meconium within 48 hours of birth.
  • Distended abdomen.
  • Vomiting.
132
Q

What findings on PR exam may indicate Hirschsprung’s disease?

A

Withdrawing of finger can result in explosive passage of stool.

133
Q

Volvulus presents with?

A
  • bilious vomiting (especially in neonates).
134
Q

What is malrotation?

A

Fixed abnormal rotation of the small bowel.

135
Q

How may malrotation present in older children?

A

Rarely presents as intermittent abdominal pain.

136
Q

Volvulus is a surgical emergency because?

A

Bowel can become necrotic due to occluded blood supply from mesentery.

137
Q

Hirschsprung’s disease is diagnosed by?

A
  • Abdominal radiograph showing distended loops of bowel.

- Confirmed by a lack of ganglionic nerve cells in rectal biopsy.

138
Q

Hirschsprung’s disease is managed by?

A
  • Surgical resection of aganglionic section and anastomosis of colon to anal canal.
    (Can be done in one operation or a colostomy can be formed with anastomosis at a later date).
139
Q

The most common form of bowel atresia is?

A

Duodenal atresia.

140
Q

Duodenal atresia is associated (30% of cases) with which chromosomal abnormality?

A

Trisomy 21 i.e. Down’s syndrome.

141
Q

Symptoms of bowel atresia include?

A
  • Vomiting (bilious if atresia distal to hepatopancreatic duct).
  • Failure to pass flatus and faeces.
142
Q

Bowel atresia is confirmed by?

A

Abdominal radiograph illustrating dilated bowel loops proximal to atresia.

143
Q

This finding on abdominal radiograph is typical of duodenal atresia.

A
  • “Double bubble”.

(Air distends stomach and first part of duodenum proximal to atresia > two bubbles and a lack of air in distal bowel.

144
Q

Biliary atresia is the?

A
  • Rare condition of atresia of the CBDs or hepatic ducts.

- Bile produced is unable to be secreted into small intestine > inflammation of bile ducts and liver.

145
Q

Biliary atresia typically presents as?

A
  • Prolonged jaundice in the first few weeks after birth (i.e. >14 days in a term infant).
  • Pale stools.
  • Dark urine.
  • Poor weight gain.
146
Q

Bloods taken in investigation of biliary atresia, typically show?

A
  • Conjugated hyperbilirubinaemia (conjugate bilirubin fraction >20% of total).
  • Deranged LFTs.
147
Q

Diagnosis of biliary atresia is confirmed by?

A

Radioisotope scans showing no excretion of radioisotope-labelled bile from the liver.

148
Q

Biliary atresia is managed by?

A
  • Hepatoportoenterostomy (Kasai’s procedure).
  • This is not curative and many require a liver transplant at a later time.
  • Higher success the earlier it is performed.
149
Q

Causes of persistent vomiting in children include?

A
  • Gastro-oesophageal reflux.
  • Pyloric stenosis.
  • Malrotation and partial obstruction.
  • Cow’s milk protein allergy,
  • UTI.
  • Increased ICP.
  • Renal failure.
  • Renal tubular acidosis.
  • Adrenal failure.
150
Q

Physiological reflux occurs in infants because?

A
  • They have an immature lower oesophageal sphincter (allows easy passage of stomach contents into oesophagus).
  • Liquid diet until weaned (6 months).
  • Most often in the supine position.
151
Q

Groups of children and infants at higher risk of gastro-oesophageal reflux include?

A
  • Premature babies.

- Children with severe neurodevelopmental problems.

152
Q

Common exacerbating factors in babies with reflux include?

A
  • Overfeeding (particularly if formula fed)
  • Lying flat after feeds.
  • Large volumes of milk at one time.
153
Q

Treatment options for gastro-oesophageal reflux in babies includes:

A
  • feed thickeners.
  • alginate therapy.
  • antacids (H2-receptor antagonist or PPI).
154
Q

In children with severe neurodisability and gastro-oeosphageal reflux, surgical management may be considered in the form of?

A
  • fundoplication to prevent aspiraiton.
155
Q

Pyloric stenosis is caused by?

A

Hypertrophy of pyloric muscle (proximal to hepatopancreatic duct) > prevents emptying of gastric contents by peristalsis.

156
Q

Factors known to increase risk of pyloric stenosis include?

A
  • Caucasians of Northern European descent (uncommon in black, asian or indian descent).
  • Male sex (4:1 of boys:girls).
  • Unknown cause but thought to have genetic link.
157
Q

Babies with pyloric stenosis tend to present?

A
  • At 3-8 weeks with projectile non-bilious vomiting.
  • Hungry and dehydrated.
  • Poor weight gain.
158
Q

Clinical signs of dehydration in an infant include?

A
  • Sunken fontanelle.
  • Mottled skin.
  • Cold hands and feet.
  • Sunken eyes.
  • Dry mucous membranes.
  • Cap refill <2s.
  • Tachycardia,
  • Lethargy.
159
Q

Examination findings suggestive of pyloric stenosis include?

A
  • Peristaltic waves across abdomen after test-feeding.

- Small firm lump i.e. “olive” may be felt in epigastric region.

160
Q

Blood tests supporting a diagnosis of pyloric stenosis may show?

A
  • Hypokalaemic hypochloraemic metabolic alkalosis (due to loss of HCl from stomach).
161
Q

A diagnosis of pyloric stenosis is confirmed by?

A

Abdominal ultrasound.

162
Q

Pyloric stenosis is managed by?

A

Surgery - Ramstedt’s pyloromyotomy (pylorus muscle cut to mucosal layer).

163
Q

Appendicitis is acute inflammation of the appendix caused by?

A

Obstruction of the appendix lumen by faecoliths.

164
Q

Appendicitis typically presents with?

A
  • Decreased appetitie.
  • Central abdominal pain later migrating to right iliac fossa.
  • Vomiting.
  • Fever.
165
Q

Examination findings in support of a diagnosis of appendicitis include?

A
  • Localised tenderness and guarding over the right iliac fossa.
  • Rebound tenderness.
166
Q

Which examination finding would suggest perforation of the appendix?

A

Generalised rigidity is present in peritonitis secondary to appendix perforation.

Fourth Year (28 decks)

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