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PAEDIATRICS Flashcards

1
Q

What are the red flag symptoms in a child presenting with failure to thrive?

A
  1. Red features on traffic light
  2. Chronic diarrhoea
  3. Developmental delay
  4. Regression i.e. weight loss
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2
Q

What are some differentials for a child presenting with failure to thrive? List as many as possible

A
  1. PRE-NATAL
    - prematurity, maternal malnutrition, congenital infections, IUGR, Toxin exposure in utero
  2. INTAKE ISSUES
    - cerebral palsy, chronic GORD, pyloric stenosis
  3. MALABSORPTION
    - Cystic fibrosis, coeliac disease, Cow’s milk protein allergy, Lactose intolerance
  4. METABOLIC DISORDERS
    - Hypothyroidism, Diabetes mellitus
  5. CONSTITUTIONAL DELAY
    - Short parents, genetic predisposition
  6. INADEQUATE FEEDS
    - NEGLECT!
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3
Q

When does GORD tend to present in children? What symptoms shall they have?

A

Typically develops before 8 weeks

- vomiting/regurgitation following feeds

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4
Q

How are children with GORD managed?

A
  1. Position during feeds - 30 degrees head up
  2. Sleep on backs still (decreases risk of cot death)
  3. Ensure not being overfed + consider smaller, frequent feeds
  4. Trial of thickened formula or alginate therapy - but never both!
  5. Only use PPI or H2 antagonist if at least one of:
    - Unexplained feeding difficulties
    - Distressed behaviour
    - Faltering growth
  6. If severe complications (e.g. FTT) + medical treatment is ineffective fundoplication may be considered
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5
Q

What are the 3 main consequences of cystic fibrosis?

A
  1. Thick pancreatic + biliary secretions = causes blockage of ducts, resulting in a lack of digestive enzymes (e.g. pancreatic lipase in digestive tract)
  2. Low volume thick airway secretions that decrease airway clearance resulting in bacterial colonisation + susceptibility to airway infections
  3. Congenital bilateral absence of vas deferens in males. They have healthy sperm but no way of getting from testes to ejaculate => male infertility
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6
Q

What are the signs + symptoms of CF?

A

SYMPTOMS:
- Chronic cough, thick sputum, recurrent RTIs, steatorrhoea, abdo pain + bloating, child has concentrated salt in sweat, poor weight + height (failure to thrive)

SIGNS:
- Low weight/height on growth charts, nasal polyps, finger clubbing, crackles + wheeze on auscultation, abdominal distension

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7
Q

How is cystic fibrosis diagnosed?

A
  1. Newborn blood spot testing picks up most cases

2. Chloride sweat test is gold standard (over 60mmol/L)

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8
Q

How is cystic fibrosis managed?

A
  1. Chest physio several times/day to clear mucus + decrease risk of infection
  2. Exercise
  3. High calorie diet
  4. Creon tablets - to digest fats in pts with pancreatic insufficiency
  5. Prophylactic flucloxacillin
  6. Treat chest infections when they occur
  7. Bronchodilators
  8. Nebulised DNAse can be secretions less viscous + easier to clear
  9. Nebulised hypertonic saline
  10. Vaccinations - pneumococcal, influenza + varicella
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9
Q

What monitoring is required in patients with CF?

A

Followed up in specialist clinics every 6 months
Require regular monitoring of sputum for colonisation
- screening also needed for diabetes, osteoporosis, vit D deficiency and liver failure

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10
Q

What is the prognosis for patients with CF?

A

Life expectancy is IMPROVING + is currently is 47 years

  • 90% develop pancreatic insufficiency
  • 50% of adults with CF develop CF related diabetes
  • 30% adults with CF develop liver disease
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11
Q

How is coeliacs disease diagnosed?

A

Jejunal biopsy showing subtotal villous atrophy

- anti-EMA and anti-gliadin antibodies are useful screening tests

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12
Q

What are the extra-intestinal features of IBD?

A
  • Clubbing
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Episcleritis + iritis
  • Inflammatory arthritis
  • PSC (only really in UC)
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13
Q

What investigations would you perform in a child with suspected IBD?

A
  1. Blood test for anaemia, infection, thyroid, kidney + liver function
  2. Faecal calprotectin
  3. Endoscopy (OGD + colonoscopy) with biopsy is gold standard
  4. Imaging - US, CT + MRI to look for complications
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14
Q

How is UC managed in kids?

A

Inducing remission:
1st = aminosalicylates (mesalazine oral or rectal)
2nd = corticosteroids
If severe use IV corticosteroids (hydrocortisone)

Maintaining:

  • aminosalicylates (mesalazine)
  • azathioprine
  • mercaptopurine
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15
Q

How is Crohns managed in kids?

A

Inducing remission:
1st = steroids
2nd = add immunosupressant meds (azathioprine, methotrexate)

Maintaining:
1st = azathioprine/mercaptopurine
Alternatives = methotrexate, infliximab, adalimumab

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16
Q

What investigations should be performed in children with suspected diabetes?

A
  1. Routine bloods
  2. Blood cultures
  3. Hb1Ac
  4. TFTs + TPO for thyroid condition
  5. tTG antibodies for coeliacs
  6. Insulin antibody, anti-GAD + islet cell antibody
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17
Q

What are the red flag symptoms in a child presenting with a rash?

A
  1. Non-blanching rash
  2. Headache
  3. Neck stiffness
  4. Photophobia
  5. Generally unwell
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18
Q

Give an example of a steroid for each level of the ladder (from mild to very potent)

A

Mild = Hydrocortisone 0.5%, 1% and 2.5%
Moderate = eumovate (clobetasone butyrate) 0.05%
Potent = Betnovate (betametasone 0.1%)
Very potent = Dermovate (clobetasol propionate 0.05%)

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19
Q

What is guttate psoriasis?

A

Transient psoriatic rash frequently triggered by strep infection
- multiple red, teardrop lesions appear on body

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20
Q

What are the 2 main types of contact dermatitis?

A
  1. Irritant contact dermatitis = common
    - non-allergic reaction due to weak acids/alkalis
    - often on hands
    - erythema, crusting, (vesicles are rare)
  2. Allergic Contact Dermatitis = type IV hypersensitivity
    - uncommon, often seen on head following hair dyes
    - acute weeping eczema
    - treatment = topical potent steroid
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21
Q

How do you manage seborrhoeic dermatitis on (i) scalp (ii) Face + body?

A

(i) OTC meds containing zinc pyrithione (head + shoulders) + tar (T gel Neutrogena)

(ii) Topical antifungals = ketoconazole
- topical steroids, best for short periods
- more tricky to treat, recurrence is common

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22
Q

What is the infectivity period of VZV (chickenpox)?

A

Infectivity = 4 days before rash until 5 days after rash appeared

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23
Q

How long should children remain off school if they have chickenpox?

A

Until all the lesions are dry + have crusted over

- usually about 5 days after onset of rash

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24
Q

What are the clinical features of cellulitis?

A

Commonly on shins

  • erythema, pain, swelling
  • may be some associated systemic upset e.g. fever
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25
Q

How is cellulitis managed?

A

Diagnosis is CLINICAL
Mild/moderate = Flucloxacillin. If allergic to penicillin use clarithromycin, erythromycin (use in pregnancy) or doxycycline
Severe = co-amoxiclav, cefuroxime, clindamycin or ceftriaxone

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26
Q

What are the clinical features of CROUP?

A

Seal-like barky cough, stridor, respiratory distress

  • symptoms worsen with agitation
  • typically kids 6months to 3 years in late Autumn
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27
Q

How is croup diagnosed?

A

CLINICALLY

- do NOT perform ENT exam as can precipitate worsening obstruction

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28
Q

How do you manage croup? (i) MILD (ii) MODERATE (iii) SEVERE?

A

(i) MILD (no stridor at rest)
1. Dexamethasone 0.15mg/kg
- review after 2-hours
- can repeat dose every 12 hours

(ii) MODERATE (stridor + sternal recession at rest)
1. Nebulised adrenaline 5ml 1:1000
2. Dexamethasone or Budesonide if severe hypoxia/vomiting/respiratory distress

(iii) SEVERE (agitation/lethargy)
1. Nebulised adrenaline 5ml 1:1000
2. Corticosteroids
3. Intubation if impending respiratory failure

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29
Q

What organism most commonly causes bronchiolitis?

A

Respiratory syncytial virus (RSV)

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30
Q

What are the symptoms of bronchiolitis?

A

At worst between days 3 and 5

  • early symptoms = blocked/runny nose, cough + slightly high temp
  • Signs of respiratory distress
  • Dyspnoea, tachypnoea
  • Poor feeding, fever less than 39 degrees
  • Apnoeas = episodes where child stops breathing
  • Wheeze + crackles on auscultation
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31
Q

How is bronchiolitis diagnosed?

A

Made clinically

- if uncertain, immunofluorescence of nasopharyngeal secretions may show RSV

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32
Q

How is bronchiolitis treated?

A

SUPPORTIVE management. Should clear within 2-3 weeks

  • ensure adequate intake of food + fluids
  • saline nasal drops + nasal suctioning can help clear secretions
  • oxygen if sats remain below 92%
  • ventilatory support if required
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33
Q

What is the difference between viral induced wheeze + asthma?

A

VIW will:

  • present before 3yrs age
  • No atopic hx
  • only occurs during viral infections

Note: asthma can be triggered by bacterial/viral infections but also has other triggers e.g. exercise, cold weather, dust + strong emotions

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34
Q

How is viral induced wheeze treated?

A

Managed the same as that for ACUTE ASTHMA

  1. Salbutamol via spacer
  2. Intermittent Montelukast and/or intermittent corticosteroids
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35
Q

What investigations are required to diagnose asthma in children?

A
  1. Spirometry with reversibility testing in children over 5y
  2. Direct bronchial challenge test with histamine or metacholine
  3. Fractional exhaled nitric oxide
  4. Peak flow variability - measured by keeping diary of measurements taken severe times a day for 2-4 weeks
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36
Q

How is asthma managed in under 5s?

A
  1. SABA
  2. SABA + 8-week trial of moderate dose ICS
    - if symptoms did not resolve consider alterative ddx
    - if symptoms stopped then returned within 4wks of stopping ICS, restart at low-dose ICS
    - if symptoms resolved but return after more than 4wks, repeat 8-week trial again
  3. SABA + low dose ICS + LTRA (Montelukast)
  4. Stop LTRA + refer to paediatric asthma specialist
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37
Q

How is asthma managed in children aged 5-16 yrs?

A
  1. SABA
  2. SABA + low dose ICS
    - if not controlled on previous step OR newly diagnosed asthma with symptoms for 3 or more times/week or night time waking
  3. SABA + low dose ICS + LTRA (Montelukast)
    - stop LTRA if it doesn’t help
  4. SABA + low-dose ICS + LABA
  5. SABA + switch LABA/ICS to MART using low dose ICS
  6. SABA + moderate dose ICS in MART
  7. SABA + one of following options:
    - increase ICS to high-dose
    - trial additional drug (theophylline)
    - advice from paeds asthma specialist
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38
Q

What are the most common causes of pneumonia in children?

A

Streptococcus pneumoniae
and
RSV

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39
Q

How is pneumonia managed in children?

A

7-day course of amoxicillin

  • add macrolide (erythromycin/clarithromycin) if no response or chlamydia/mycoplasma
  • if penicillin allergic give erythromycin or clarithromycin

Oxygen to maintain sats above 92%

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40
Q

What is bronchiectasis?

A

Permanent dilatation of bronchi due to destruction of muscular components of bronchial wall
- recurrent pulmonary infection leads to progressive bronchial damage

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41
Q

What are some risk factors for developing bronchiectasis in children?

A
  1. CF
  2. Immunodeficiency
  3. Previous infections
  4. Congenital disorders of bronchii
  5. Alpha-1 antitrypsin deficiency
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42
Q

What is the gold standard investigation to diagnose bronchiectasis?

A

High-resolution CT

  • dilatation of bronchi
  • thickened airways
  • cysts
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43
Q

How do you manage children with bronchiectasis?

A
  1. Exercise + improved nutrition
  2. Airway clearance therapy
  3. Inhaled bronchodilator e.g. salbutamol
  4. Inhaled hyperosmolar agent e.g. hypertonic saline (inh)
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44
Q

What can pseudomonas colonisation be treated with long term?

A

Nebulised tobramycin

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45
Q

What are the 3 shunts in a foetus which allow blood to bypass the lungs?

A
  1. Ductus venosus = connects umbilical vein to IVC + allows blood to bypass liver
  2. Foramen ovale = connects RA with LA + allows blood to bypass RV + pulmonary circulation
  3. Ductus arteriosus = connects pulmonary artery with aorta + allows blood to bypass pulmonary circulation
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46
Q

What keeps the ductus arteriosus open?

A

Prostaglandins

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47
Q

What closes the ductus arteriosus?

A

Increase in blood oxygenation causes a DROP in prostaglandins

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48
Q

What are the characteristics of an innocent murmur? (HINT: the 5 S’s)

A
  1. Soft
  2. Short
  3. Systolic
  4. Symptomless
  5. Situation dependent - particularly if it gets quieter with standing or only appears when child is unwell/feverish
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49
Q

What are features of a murmur which would prompt further investigations + referral to paediatric cardiologist?

A
  1. Murmur louder than 2/6
  2. Diastolic murmurs
  3. Louder on standing
  4. Other symptoms e.g. failure to thrive, feeding difficulty, cyanosis or SOB
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50
Q

What are the differentials for a pan-systolic murmur in children?

A
  1. Mitral regurgitation heard loudest at mitral area
  2. Tricuspid regurgitation heard loudest at tricuspid area
  3. VSD loudest at lower left sternal border
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51
Q

What are the differentials for an ejection systolic murmur in children?

A
  1. Aortic stenosis - aortic area
  2. Pulmonary stenosis - pulmonary area
  3. HOCM - heard at 4th ICS on left sternal border
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52
Q

What murmur is it in an ASD?

A

Mid-systolic, crescendo-decrescendo murmur

- with a fixed split second heart sound

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53
Q

What murmur is heard in PDA?

A

If small, heart sounds may be normal
- if significant, they cause a normal first heart sound with continuous crescendo-decrescendo ‘machinery’ murmur which may continue to second heart sound

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54
Q

What murmur is heard in tetralogy of fallot?

A

Murmur arises from pulmonary stenosis => ejection systolic murmur

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55
Q

What is Eisenmenger syndrome?

A

When the pulmonary pressure is greater than the systemic pressure, this reverses the shunt from a L to R to a right to left shunt across

  • this causes blood to bypass the lungs, causing cyanotic heart disease
  • can occur in ASD, VSD or PDA
56
Q

What is the difference in shunts of blood flow in cyanotic and acyanotic heart disease? Give examples of conditions for each.

A

CYANOTIC = Right to left shunt
e.g. Tetralogy of Fallot, Ebstein’s anomaly, transposition of great arteries, tricuspid atresia

ACYANOTIC = left to right shunt
e.g. PDA, ASD, VSD, Coarctation of aorta, aortic valve stenosis

57
Q

What heart defect is Downs syndrome commonly associated with?

A

Ventricular septal defects

58
Q

What heart abnormalities is Turner’s syndrome associated with?

A

VSD + Coarctation of aorta

59
Q

What are the 4 features which make up Tetralogy of Fallot?

A
  1. VSD
  2. Overriding aorta (= aortic valve placed further right than normal)
  3. Pulmonary valve stenosis
  4. RV hypertrophy
60
Q

What are some differentials for paediatric convulsions?

A
  1. Febrile convulsions
  2. Reflex anoxic seizures
  3. breath holding attacks
  4. Epilepsy
  5. Meningitis
  6. Tuberous sclerosis
  7. Hypoglycaemia
  8. Vasovagal syncope
  9. BPPV
61
Q

In what conditions is there an increased risk of developing epilepsy?

A
  1. Tuberous sclerosis
  2. Cerebral palsy
  3. Mitochondrial diseases
62
Q

What are the symptoms of a focal seizure?

A

Start in a specific area on one side of the brain

  • can affect hearing, speech, memory + emotions
  • hallucinations
  • memory flashbacks
  • deja vu
  • lasts a few mins
63
Q

What medication is used for focal seizures?

A

1st = carbamazepine or lamotrigine

64
Q

What medication is used to treat generalised seizures?

A

Sodium valproate 1st

2nd line = lamotrigine

65
Q

When is a seizure classed as status epilepticus?

A

More than 5 mins duration of seizure or 3 or more seizures in an hour

  • if febrile seizure, it lasts more than 30 mins to be status epilepticus
66
Q

How do you manage status epilepticus?

A 
In community:
- buccal midazolam or rectal diazepam 
In Hospital:
- secure airway
- high flow O2
- assess CVS + RS
- check BMs
1st line = IV lorazepam
If seizures persist give IV phenytoin or phenobarbital
67
Q

What is the antibiotic management for bacterial meningitis in patients under 3 months?

A

Cefotaxime plus amoxicillin

- steroids may be given to reduce hearing loss + neuro damage

68
Q

What is the antibiotic management for bacterial meningitis in patients over 3 months?

A

Cefotaxime or Ceftriaxone

69
Q

What are contraindications to performing a LP?

A
  • focal neuro signs
  • papilloedema
  • significant bulging of fontanelle
  • DIC
  • signs of cerebral herniation
70
Q

What are the red flag features for a child presenting with developmental delay?

A
  1. Red light features on traffic light
  2. Loss of skill at any age
  3. Not fixing/following objects
  4. Cannot sit unsupported by 12 months
  5. No speech by 18 months
  6. Not standing by 18 months
  7. Persistent toe walking
  8. Loss of hearing
71
Q

What are some differentials for causes of a delay in motor development?

A
  • Normal variation e.g. children who are bottom shufflers or commando crawlers are more likely to develop walking skills later
  • Cerebral palsy
  • Duchenne’s muscular dystrophy
  • Down’s syndrome, tuberous sclerosis
  • Ricket’s, hypoglycaemia
  • Environmental = child always kept in cot or bedbound through illness
72
Q

What is gowers sign?

A

Child uses hands to ‘climb up’ legs in order to stand up

- sign of Duchenne’s

73
Q

What are some differentials for causes of a delay in speech + language development?

A
  • Normal variation e.g. FHx of delayed language development
  • Hearing troubles e.g. glue ear
  • autism spectrum disorder = deficit in social interaction, communication + flexible behaviour
  • Cleft palate
  • Learning difficulties
  • environmental deprivation + neglect
74
Q

What are the red flags for paediatric vomiting?

A
  1. Projectile vomiting
  2. Less than 50% feeds taken
  3. Absence of wet nappies
  4. Red features on traffic light
  5. Non-blanching rash
  6. Symptoms of UTI
75
Q

What are some differentials for paediatric vomiting?

A
  • GORD
  • Pyloric stenosis
  • Intussusception
  • Coeliacs
  • meningitis
  • gastroenteritis
76
Q

What is the management plan for children with GORD?

A
  1. Feed with 30 degree head tilt
  2. Do not overfeed + try small more frequent feeds
  3. Can try thickened formula OR alginate therapy (Gaviscon)
    - cannot use both together!
  4. PPI/H2RA
77
Q

When would you use a PPI in a child with GORD?

A
  • unexplained feeding difficulties e.g. refusing feeds, gagging, choking
  • distressed behaviour
  • faltering growth
78
Q

What common biochemical abnormality is seen in pyloric stenosis?

A

Hypochloraemic, hypokalaemic metabolic alkalosis

- due to persist vomiting

79
Q

How is pyloric stenosis diagnosed?

A

Abdominal USS to visualise thickened pylorus

80
Q

How is pyloric stenosis treated?

A

Laparoscopic pyloromyotomy

- known as Ramstedt’s operation

81
Q

How does intussusception present?

A

Infants 6-18 months

  • severe, colicky abdominal pain (every 10-20 mins)
  • pale, lethargic + unwell child
  • redcurrant jelly stool
  • RUQ mass on palpation (sausage shaped)
  • vomiting (rapidly becomes bile stained)
  • intestinal obstruction
82
Q

How is intussusception diagnosed?

A

USS (shows characteristic target sign) or contrast enema

83
Q

How is intussusception managed?

A

Therapeutic enema, if this does not work then surgical reduction is required (or if bowel becomes gangrenous or perforated)
- Abx and analgesia

84
Q

What age does coeliac disease tend to present in children?

A

peak at 9 months to 3 years (typically after weaning)

85
Q

How does coeliac disease present?

A
  • failure to thrive
  • diarrhoea (steatorrhoea)
  • fatigue
  • weight loss
  • mouth ulcers
  • anaemia 2ndary to iron, B12 or folate deficiency
  • dermatitis herpetiformis (= itchy blistering skin rash which you can get on the abdomen)
86
Q

How is coeliac disease diagnosed?

A
  1. Raised anti-TTG (1st choice)
  2. Raised anti-EMA
  3. Endoscopy with intestinal biopsy is gold standard
    - crypt hypertrophy + villous atrophy
87
Q

What antibiotics are used to treat bacterial meningitis in children under 3 months?

A

Cefotaxime plus amoxicillin

88
Q

What antibiotics are used to treat bacterial meningitis in children over 3 months?

A

Cefotaxime OR ceftriaxone

89
Q

What are some complications which can occur in children post-gastroenteritis?

A
  • lactose intolerance
  • IBS
  • Reactive arthritis
  • Guillain-Barre syndrome
90
Q

What is the typical presentation of lactose intolerance in children?

A

Commonly post-viral infection + is short lasting (4-6wks)

  • diarrhoea, excessive flatus, colic, peri-anal excoriation
  • stool pH less than 5
91
Q

What are the typical features of cows milk protein allergy/intolerance?

A
  • vomiting + diarrhoea
  • urticaria, atopic eczema
  • colic = irritability, crying
  • wheeze, chronic cough

rarely, angioedema + anaphylaxis may occur

92
Q

How do you diagnose CMPA?

A

Diagnosis is often clinical (e.g. improvement with cow’s milk protein elimination).
Investigations include:
- skin prick/patch testing
- total IgE and specific IgE (RAST) for cow’s milk protein

93
Q

How do you manage cows milk protein allergy/intolerance?

A

FORMULA FED:
- use hydrolysed formula milk
BREAST-FED:
- maternal exclusion required

94
Q

What is the outlook/prognosis for children with cows milk protein intolerance/allergy?

A
  • in children with IgE mediated intolerance around 55% will be milk tolerant by the age of 5 years
  • in children with non-IgE mediated intolerance most children will be milk tolerant by the age of 3 years

A test of reintroduction can be done in hospital if high risk of anaphylaxis

95
Q

How do you manage necrotising enterocolitis?

A

STOP milk feeds for 10-14 days
- insert NG tube on free draining
IV Abx for 10-14 days e.g. benzylpenicillin
- may need surgery

96
Q

What are the clinical features of Henoch-Schonlein Purpura ?

A
  • palpable purpuric rash (with localised oedema) over buttocks and extensor surfaces of arms and legs
  • abdominal pain, typically colicky
  • polyarthritis: short lived affecting large joints (knees, ankles, elbows)
  • features of IgA nephropathy may occur e.g. haematuria, renal failure, proteinuria
  • may also have malaena, haematemesis, intussusception, perforation, appendicitis
97
Q

How do you manage HSP?

A

Condition is self-limiting - should resolve within 6 weeks

  1. Analgesia for arthralgia e.g. NSAIDs
  2. Steroids can help with abdominal pain + joints
  3. Monitor for any renal failure if suspected
  • around 1/3rd will relapse
98
Q

What is the typical triad of features in haemolytic uraemic syndrome?

A
  • acute kidney injury
  • microangiopathic haemolytic anaemia
  • thrombocytopenia
99
Q

What investigations should be performed in suspected HUS?

A
  1. FBC: anaemia, thrombocytopaenia, fragmented blood film
  2. U+E - AKI
  3. Stool culture
  4. Looking for evidence of STEC infection (E.Coli 0157)
  5. PCR for Shiga toxins
100
Q

How do you manage HUS?

A
  1. Treatment is SUPPORTIVE = Fluids, blood transfusion and dialysis if required
    - NO role for antibiotics
101
Q

What is the most common cause of diarrhoea in children aged 6 months to 5 years?

A

Toddlers diarrhoea

  • reassure, dietary advice = increase fat intake, decrease milk + fruit juice consumption
  • loperamide occasionally needed if severe
102
Q

What is Hirschsprung’s disease? Who does it tend to affect?

A

Aganglionic segment of bowel causing absence of co-ordinated peristalsis + functional intestinal obstruction at junction (transition zone)
- common in children with downs syndrome + in males

103
Q

How does Hirschsprung’s disease tend to present?

A

Usually within first few days of life with low intestinal obstruction i.e. failure to pass meconium, abdominal distension + billous vomiting

104
Q

What investigations should be performed in Hirschsprung’s?

A
  1. AXR = distal intestinal obstruction
  2. Rectal biopsy = GOLD STANDARD
    - no ganglion cells in submucosa
105
Q

How is Hirschsprung’s disease managed?

A
  1. Initially: rectal washouts/bowel irrigation

2. Definitive management: surgery to affected segment of the colon (single-stage pull through)

106
Q

What are some GI + non-GI causes of constipation in children?

A

GI:

  • Hirschsprung’s disease
  • Anal disease = infection, stenosis, ectopic, fissure
  • Partial intestinal obstruction
  • Food hypersensitivity
  • Coeliac’s

Non-GI:

  • Hypothyroidism
  • Hypercalcaemia
  • Neuro diseases e.g. spinal disease
  • Chronic dehydration (diabetes insipidus)
  • Drugs (opiates, anticholinergics)
  • Sexual abuse
107
Q

How do you manage constipation in kids?

A

Increase oral fluid + fibre intake
- natural laxatives e.g. fruit juice + dried fruits
Regular 5 min toilet time after meals
- encourage + praise visiting toilet, could have scheduling visits, bowel diary or star chart

Medication can be used for disimpaction + maintenance

  • treat for at least 3 months
  • faecal softeners = movicol or lactulose
108
Q

What is normal physiological jaundice?

A

Appears after 24hrs

  • peaks around days 3-4 + usually resolves by 14 days
  • due to immaturity of hepatic bilirubin conjugation but poor feeding can contribute
  • foetal Hb breakdown high as has shorter lifespan, liver cannot cope with all bilirubin
109
Q

What are some causes of jaundice which presents within the first 24h of birth?

A
  • haemolysis from ABO incompatibility
  • Rhesus disease of newborn
  • Hereditary spherocytosis
  • infection of mothers genital tract/amniotic fluid
  • sepsis from TORCH infections
  • severe bruising
110
Q

How many days does jaundice have to be present to be prolonged? (HINT: different in term + pre-terms)

A

more than 14 days in term babies

- more than 21 days in pre-term babies

111
Q

What are some causes of prolonged jaundice?

A
  • breastfeeding (benign, self-limiting, usually resolves by 12 wks)
  • enclosed bleeding (cephalhaematoma)
  • prematurity
  • haemolysis
  • sepsis (CMV, toxoplasmosis)
  • hypothyroidism
  • biliary atresia
  • conjugated jaundice
  • hepatic enzyme disorders (Crigler-najjar syndrome, lucy-driscoll disease)
112
Q

What is kernicterus?

A

When bilirubin is greater than 360micromol/L + crosses blood brain barrier

  • lethargy
  • coma
  • poor feeding
  • fits
113
Q

What investigations should you perform in a jaundices neonate?

A
  1. Thorough hx + exam
  2. Bloods: bilirubin, FBC, blood film, blood group, LFT, TFT
  3. Blood culture
  4. Coombs test
  5. Urine dipstick - r/o sepsis
  6. USS - r/o biliary atresia
114
Q

In what condition do you see a double-bubble sign on abdominal x-ray? Who does this condition tend to affect?

A

Duodenal atresia

- children with Down’s syndrome, presents in first few hours after birth

115
Q

How do you treat duodenal atresia?

A

Early = remove fluid from stomach via NG tube + give fluids IV

Definitive treatment is surgery (Duodenoduodenostomy)

116
Q

How do you diagnose ITP?

A

FBC - low platelet count in isolation with otherwise normal results

Should exclude secondary causes:
- leukaemia, heparin induced thrombocytopenia

117
Q

What information do you need to give to parents whose children have ITP?

A

Usually no treatment required + should return to normal within 3 months

  • most severe bleeds tend to happen in first week + platelets under 20
  • those with platelet count over 20 can return to school immediately. If below 20, can return in 1 week
  • avoid contact sports whilst platelets below 50
  • avoid holidays abroad for 3 months
118
Q

What are the clinical features of Kawasaki disease?

A
  1. High grade fever which lasts for more than 5 days + resistant to antipyretics
  2. Conjunctival injection (red eyes)
  3. Bright red, cracked lips
  4. Strawberry tongue
  5. Cervical lymphadenopathy
  6. Red palms + soles, which later peel
119
Q

How is Kawasaki disease diagnosed + managed?

A

Diagnosed clinically

  • high dose aspirin
  • IVIG
  • Echo - used to screen for coronary artery aneurysm
120
Q

What is still’s disease? What are the clinical features?

A

Systemic onset JIA

  • pyrexia
  • salmon-pink rash
  • lymphadenopathy
  • arthritis
  • uveitis
  • anorexia/weight loss
121
Q

What is enthesitis? What group of conditions is it associated with?

A

Inflammation of the point at which tendon of muscle inserts into bone

HLA-B27 conditions = psoriatic arthritis, reactive arthritis, IBD-related arthritis

122
Q

What are the red flags in a paediatric limp presentation?

A
  1. Nocturnal pain, night sweats, weight loss = ALL
  2. High fever, holding leg abducted, not allowing internal rotation due to pain = Septic arthritis
  3. High fever, non-weight bearing = osteomyelitis of femur/pelvis
  4. Changing hx/unusual mechanism of injury = NAI
123
Q

Who does transient synovitis of hip tend to affect? When does it tend to occur?

A

2-12 yrs age.
2x as common in BOYS
- temporary inflammation secondary to viral URTI

124
Q

How is transient synovitis managed?

A

SELF-LIMITING

  • Rest
  • analgesia (ibuprofen)

F/U recommended at 7-10 days

125
Q

Who does Perthe’s disease tend to affect? What is the underlying mechanism behind it?

A

4-8 yrs old
5x more common in BOYS
- caused by avascular necrosis of femoral head

126
Q

What are the clinical features of Perthe’s?

A
  1. Hip pain:
    - onset over weeks
  2. Limp
  3. Stiffness and reduced range of hip movement
127
Q

What are the features on x-ray to indicate Perthe’s disease?

A

Early changes = widening of joint space

Later changes = decreased femoral head size/flattening

128
Q

How is Perthe’s disease managed?

A

1) Treat Acute Pain + rest during acute exacerbation
2) Abduction plasters to keep femoral head in acetabulum if symptoms severe
3) UNDER 6 YRS = observation, non-surgical methods above
4) OLDER: surgical (containment/salvage) management with moderate results
- in children over 12 there is poor prognosis as limited remodelling potential

129
Q

Who does SUFE tend to affect? What is SUFE?

A

10-15 YRS
- obese + males
= Displacement of the femoral head epiphysis postero-inferiorly

130
Q

What clinical features are seen in SUFE?

A
  1. Pain
  2. Leg held in external rotation
  3. Abnormal gait/limp- Trendelenburg gait
  4. Decreased ROM
  5. Weakness + muscle atrophy
131
Q

What is the diagnostic investigation for SUFE?

A

AP + lateral (typically frog leg) x-rays

- Klein lines drawn along femoral neck do not intersect epiphysis

132
Q

How do you manage SUFE’s?

A

INTERNAL FIXATION: typically a single cannulated screw placed in the center of the epiphysis
- done BILATERAL even if symptomatic on only one side

133
Q

What are risk factors for developmental dysplasia of the hip?

A
  1. FHx of DDH
  2. Breech baby
  3. Female sex
    - more sensitive to mothers hormones = ligaments lax
  4. Fixed foot deformity
  5. Torticollis
134
Q

What screening is performed for DDH?

A

Screening at newborn + 6-week check:
- Ortolani + Barlow tests

Positive if able to dislocate + relocate hip

135
Q

What are clinical features you will see on examination in DDH?

A
  • leg length discrepancy
  • limitations in hip abduction due to contractures
  • Trendelenburg gait + toe walking
  • Asymmetrical buttock creases
  • hip locking/clicking
  • pain
136
Q

What investigation(s) should be performed in DDH?

A

USS in infants under 4.5 months

Older = AP pelvic x-ray

137
Q

How is DDH managed?

A

Most unstable hips will spontaneously stabilise by 3-6 weeks of age.

  1. LESS THAN 6 MONTHS = Pavlik harness (dynamic flexion-abduction orthosis)
  2. 6-18 MONTHS/FAILURE OF HARNESS
    - closed reduction + spica casting
  3. OVER 18 MONTHS/FAILURE OF ABOVE
    - Surgery = open reduction + hip reconstruction

FINALS (14 decks)

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