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Paediatrics Flashcards

1
Q

Aetiology of Meckel Diverticulum

A

Ileal remnant of vitello-intestinal duct

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2
Q

What type of tissue does Meckel Diverticulum contain?

A

Ectopic gastric mucosal pancreatic tissue

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3
Q

Presentation of Meckel Diverticulum

A

Mostly asymptomatic

Severe rectal bleeding, intussusception, volvulus, diverticulitis

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4
Q

Investigation of Meckel Diverticulum

A

Technetium scan

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5
Q

Management of Meckel Diverticulum

A

Surgical resection

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6
Q

Aetiology of Biliary atresia

A

Extra-hepatic bile ducts obliterated by inflammation and fibrosis –> biliary obstruction –> jaundice

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7
Q

Presentation of Biliary atresia

A

Jaundice
FTT
Conjugated hyperbilirubinaemia

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8
Q

How is Biliary atresia diagnosed?

A

Liver histology

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9
Q

Management of Biliary atresia

A

Surgery

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10
Q

Presentation of Duodenal atresia

A

Polyhydramnios

Persistent billious vomiting, within hours of birth

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11
Q

Investigation of Duodenal atresia

A

Can diagnose on USS

Double bubble sign on x-ray

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12
Q

Which genetic condition is Duodenal atresia associated with?

A

Trisomy 21- Down’s Syndrome

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13
Q

Management of Duodenal atresia

A

Surgery

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14
Q

Define Gastro-oesophageal reflux

A

Non-forceful regurgitation of milk and other gastric contents into the oesophagus

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15
Q

Aetiology of GORD

A

Incompetent sphincter at the Gastro-Oesophageal junction

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16
Q

Risk factors for GORD in children

A

Prematurity

Hiatus hernia

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17
Q

Presentation of GORD in children

A

Epigastric pain
Recurrent regurgitation/vomiting
Episodes of choking
FTT

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18
Q

How is GORD diagnosed?

A

Clinically

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19
Q

Management of GORD in children?

A

Thickened feeds, alginate formula
PPI/H2 receptor antagonist
Fundoplication

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20
Q

Which sign is seen on x-ray in Duodenal atresia?

A

Double bubble sign

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21
Q

At what age does Cow’s milk protein allergy usually present?

A

< 1 year old

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22
Q

Types of Cow’s milk protein allergy

A

IgE or non-IgE

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23
Q

How can a breast-fed baby present with Cow’s milk protein allergy?

A

It can be a reaction to mum’s consumption of Cow’s milk

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24
Q

How does Cow’s milk protein allergy present?

A

IgE: within 2 hours; skin itchy, V+D, wheeze, cough

Non-IgE: within hours/days; atopic eczema, reflux, constipation/diarrhoea, FTT

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25
Q

Diagnosis of Cow’s milk protein allergy

A

IgE: skin prick test

Non-IgE: exclusion + see

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26
Q

Management of Cow’s milk protein allergy

A

Hydrolysed/elemental formula

Anti-histamines for acute IgE

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27
Q

What is the typical appearance of stool in Toddler’s Diarrhoea?

A

Peas and carrots

1st stool of day large, then others small

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28
Q

At what age does Toddler’s Diarrhoea typically present?

A

6-20 months

Usually resolves by age 5

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29
Q

Management of Toddler’s Diarrhoea

A

Adequate fat and fibre to slow gut

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30
Q

What is Gastroschisis?

A

Bowel protrudes through a defect in the anterior abdominal wall, no covering sac
Risk of dehydration and protein loss

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31
Q

Management of Gastroschisis

A

Abdomen wrapped in film to protect
NG tube aspirated
IV dextrose infusion
Surgery

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32
Q

What is the difference between Gastroschisis and Exomphalos?

A

Exomphalos is covered by a sac, Gastroschisis is not

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33
Q

What is Exomphalos?

A

Abdominal contents protrude through the umbilical ring, transparent sac formed by amniotic membrane and peritoneum

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34
Q

Management of Exomphalos

A

Surgery

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35
Q

At what age does Pyloric Stenosis typically present?

A

2-8 weeks old

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36
Q

Presentation of Pyloric Stenosis

A

Projectile vomiting, not bile-stained (as above ampulla of vater)
Weight loss, FTT, hungry after feeds
Visible gastric peristalsis, palpable abdominal mass

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37
Q

How is Pyloric Stenosis diagnosed?

A

USS abdomen

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38
Q

What electrolyte abnormalities are seen in Pyloric Stenosis?

A

Vomiting –> Hypokalaemia, hypochloraemia

Metabolic alkalosis

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39
Q

Management of Pyloric Stenosis

A

Rehydration + electrolytes

Ramstedt’s pylorotomy

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40
Q

What is the most common location for Intussusception?

A

Proximal bowel into distal bowel

Ileum into caecum via the ileo-caecal valve

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41
Q

What is the most common age of presentation of Intussusception?

A

3 months - 2 years

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42
Q

Presentation of Intussusception

A

Severe colicky abdominal pain, draws knees up to chest, pale, screaming in pain, vomiting (may become billious)
Redcurrent jelly stool
RLQ sausage-shaped mass

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43
Q

In which condition is redcurrent jelly stool and a RLQ sausage-shaped mass seen?

A

Intussusception

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44
Q

How is Intussusception diagnosed?

A

Abdominal USS

- Target sign

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45
Q

What is seen on Abdominal USS in Intussusception?

A

Target sign

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46
Q

Management of Intussusception

A

Rectal air insufflation

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47
Q

Aetiology of Intestinal Malrotation

A

Congenital anomaly of rotation of the midgut –> obstruction –> volvulus –> infarction

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48
Q

At what age does intestinal malrotation typically present?

A

Day 1-7

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49
Q

Presentation of intestinal malrotation

A

Billious vomiting, abdominal pain, tenderness

50
Q

How is intestinal malrotation diagnosed?

A

Upper GI contrast study

51
Q

Management of intestinal malrotation

A

SURGICAL EMERGENCY

Surgery- Ladd’s procedure- rotates bowel anti-clockwise

52
Q

Causes of jaundice in babies < 24hrs old

A

TORCH infection
Haemolytic eg rhesus incompatibility
G6PD deficiency

53
Q

Causes of jaundice in babies age 24hrs-2 weeks

A

Physiological (or infection)

54
Q

Causes of jaundice in babies age > 2 weeks

A 
TORCH infection
Hypothyroidism
Pyloric Stenosis
Biliary atresia- pale stool + raised conjugated bilirubin
Neonatal hepatitis
55
Q

What infections are included in TORCH screen?

A

Toxoplasma
Rubella
CMV
Herpes Simplex Virus

56
Q

What is Necrotising Enterocolitis?

A

Bacterial invasion of ischaemic bowel wall

57
Q

In what group is Necrotising Enterocolitis most common?

A

Premature babies

58
Q

When does Necrotising Enterocolitis usually present?

A

In the 1st few weeks

59
Q

Presentation of Necrotising Enterocolitis

A

Billious vomiting, abdominal pain + distension, fresh blood in stool

60
Q

Investigations of Necrotising Enterocolitis

A

Investigations for sepsis

Abdominal x-ray

61
Q

What is found on abdominal x-ray in Necrotising Enterocolitis?

A

Distended bowel loops, thickening of bowel wall with intramural gas
Football sign on x-ray

62
Q

Management of Necrotising Enterocolitis

A

ABCDE if shocked
Stop oral feeds
Broad spectrum Antibiotics
Surgery for perforation

63
Q

Aetiology of Hirschsprung’s disease

A

Large bowel obstruction due to absence of ganglionic cells from myenteric plexus of large bowel

64
Q

What is the most commonly affected portion of bowel in Hirschsprung’s disease?

A

Recto-sigmoid

65
Q

Presentation of Hirschsprung’s disease

A

Failure to pass meconium within 1st 48hrs of life

Later bile-stained vomit

66
Q

Risk factors for Hirschsprung’s disease

A

Boys

Downs syndrome

67
Q

What is found on PR examination in Hirschsprung’s disease?

A

Withdrawal causes flow of liquid stool + flatus

68
Q

How is Hirschsprung’s disease diagnosed?

A

Suction rectal biopsy is diagnostic

69
Q

Management of Hirschsprung’s disease

A

Enema + surgical resection

70
Q

Aetiology of Kernicterus

A

Unconjugated bilirubin is deposited in the basal ganglia

Causes encephalopathy- seizures, coma and choreoathetoid cerebral palsy

71
Q

Management of neonatal jaundice

A

Phototherapy

Exchange transfusion

72
Q

What are the 3 features of Nephrotic Syndrome?

A
  1. Hypoalbuminaemia < 25g/L
  2. Proteinuria > 1
  3. Oedema
73
Q

Causes of Nephrotic Syndrome

A

Minimal change disease

Post-strep nephritis

74
Q

Management of Nephrotic Syndrome

A

Steroid-sensitive- Prednisolone PO
Not steroid-sensitive- Diuretics, salt restriction, ACEi, NSAIDs
Cyclophosphamide

75
Q

Clinical features of Haemolytic uraemic syndrome

A

Acute renal failure
Thrombocytopenia
Microangiopathic haemolytic anaemia
Abdo pain, reduced urine output, normocytic anaemia

76
Q

Management of Haemolytic uraemic syndrome

A

Symptomatic management

Plasma exchange if severe

77
Q

Aetiology of Haemolytic uraemic syndrome

A

Usually follows bloody diarrhoea- E coli

78
Q

Most common aetiology of Henoch-Schonlein purpura

A

Strep pyogenes URTI

79
Q

Presentation of Henoch-Schonlein purpura

A

Purpura- rash buttocks + extensor surfaces
Arthritis
Abdo pain
Haematuria, proteinuria

80
Q

Management of Henoch-Schonlein purpura

A

Oral prednisolone

81
Q

Causes of Nephritic Syndrome

A

Post-streptococcal, HSP, Anti-glomerular basement membrane disease, IgA nephropathy, SLE

82
Q

Presentation of Nephritic Syndrome

A

Haematuria, reduced urine output, fluid retention, proteinuria, hypertension

83
Q

Management of Nephritic Syndrome

84
Q

In what age group does Wilm’s tumour typically present?

A

Children < 5

85
Q

What is Wilm’s tumour?

A

Kidney tmour

86
Q

Presentation of Wilm’s tumour

A

Mass in abdomen

Abdominal pain, haematuria, lethargy, fever, hypertension, weight loss

87
Q

Investigation of Wilm’s tumour

A

USS Kidneys
CT abdomen
Biopsy

88
Q

Management of Wilm’s tumour

A

Surgical excision + nephrectomy

89
Q

Most common causative organism of Meningitis

A

Neisseria meningitidis

90
Q

Features of seizures in West syndrome

A

Head nodding, arm jerk, EEG shows hypsarrhythmia

91
Q

How is Status Epilepticus defined?

A

Tonic clonic seizures lasting > 30 minutes

92
Q

Management of Status Epilepticus

A

Buccal Midazolam –> IV Lorazepam –> IV Phenytoin

93
Q

What are febrile seizures?

A

Tonic clonic seizures with a fever

94
Q

Management of Meningitis

A

IM Benzylpenicillin in GP

IV Ceftriaxone in hospital

95
Q

Management of contacts in Meningitis

A

PO Rifampicin

96
Q

Aetiology of Asthma

A

Reversible airway obstruction

  • -> Bronchospasm
  • -> Mucosal swelling + inflammation
  • -> Increased mucous production –> mucous plug
97
Q

Presentation of Asthma

A

Wheeze
Nocturnal cough
Diurnal variation
Intermittent dyspnoea

98
Q

Findings on spirometry in Asthma

A

FEV1:FVC < 70%

With bronchodilator reversibility > 12%

99
Q

Management of an acute exacerbation of Asthma

A 
OSHITME:
- Oxygen
- Salbutamol nebs
- Hydrocortisone IV
- Ipratropium bromide nebs
- Magnesium sulphate
- Escalate
(ABCDE)
100
Q

Management of chronic Asthma

A

1) SABA (Salbutamol)
2) SABA + Inhaled corticosteroid (Beclomethasone)
3) SABA + ICS + Leukotriene receptor antagonist (Montelukast)
4) SABA + ICS + LABA (Salmeterol)

101
Q

How is life-threatening Asthma defined?

A

3392 CHEST

  • PEFR < 33% predicted
  • Sats < 92%
  • Cyanosis
  • Hypotension
  • Exhaustion
  • Silent chest
  • Tachycardia
102
Q

What is the peak age for croup?

A

6mths - 6yrs

103
Q

What is the causative organism of croup?

A

Parainfluenza virus

104
Q

Presentation of croup

A

Barking cough, stridor, fever, hoarseness

Worse at night

105
Q

Anatomical name for croup

A

Laryngotracheobronchitis

106
Q

Management of croup

A

Oral Dexamethasone 0.15mg/kg or nebulised Budenoside

Severe: O2 + Adrenaline

107
Q

What is the causative organism of acute epiglottitis?

A

Haemophilus influenza B

108
Q

Presentation of acute epiglottitis

A

Sore throat, unable to speak/swallow

Soft inspiratory stridor

109
Q

Management of acute epiglottitis

A

DO NOT EXAMINE THROAT- medical emergency
Call anaesthetics
IV Cefuroxime

110
Q

What is the causative organism of Whooping cough?

A

Bordatella pertussis

111
Q

Presentation of Whooping cough

A

Inspiratory whoop- forced inspiration against a closed glottis
Coughing spasms –> vomiting

112
Q

Diagnosis of Whooping cough

A

Nasal culture swab

113
Q

Management of Whooping cough

A

Azithromycin 5-7 days
School exclusion
Incubation period 10-14 days

114
Q

What is the most common causative organism of Bronchiolitis?

A

80% Respiratory Syncytial Virus

115
Q

At what age is Bronchiolitis most common?

A

1-9 months

116
Q

Presentation of Bronchiolitis

A 
Nasal flaring
Head bobbing
Subcostal/Intercostal recessions
Tracheal tug
Grunting
High-pitched wheeze
117
Q

Investigations of Bronchiolitis

A

PCR analysis of nasal secretions

CXR- hyperinflation

118
Q

Management of Bronchiolitis

A

Oxygen
NG feeds
Fluids

119
Q

Genetic aetiology of Cystic Fibrosis

A

Autosomal recessive defect in CFTR protein on chromosome 17

Defect in cAMP regulated chloride channels in cell membranes

120
Q

How is Cystic Fibrosis screened for?

A

Guthrie heelprick age 6-9 days

Finals Revision (13 decks)

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