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Clinical Medicine > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the components of a newborn examination

A 
Cardiac/resp
Red reflex
Fontanelle
Face and mouth
Abdomen
Nappy area
Hips 
Limbs
Prone
Reflexes
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2
Q

What are the components of a newborn cardiac/resp exam

A

Listen to 4 areas over the chest, including with the bell- less than 200 bpm is pathologic
- May have innocent murmurs due to flow velocity change in different sized vessels
Anterior resp auscultation is enough in absence of signs
More than 60 breaths is pathologic
Can auscultate abdomen here but low yield
- Inspect and palpate chest after auscultation

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3
Q

What are the components of a newborn red reflex exam

A
  • Baby needs to be awake and in a dimmed room, looking through ophthalmoscope with both eyes
  • Looking for asymmetry or whitening
  • Could indicate congenital cataract/glaucoma or retinoblastoma
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4
Q

Describe the anatomy of a fontanelle

A

Sutures are coronal, saggital, metopic and lambdoid

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5
Q

Describe the components of a fontanelle exam

A

Feel along sutures and both ant and post fontanelles
May initially feel as if they overlap due to pressure from birth
ABNORMAL if no suture or ridge feeling- may be due to pressure from early fusion (craniosynostosis)
Widening within the saggital suture may be due to trisomy 21
If wormian bones are present they will feel like cracked eggshell

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6
Q

Describe components of neonatal face and mouth exam

A

Look for any abnormalities in skull shape and facial symmetry (but check the parents!)
Palate- look at uvula and feel/look at palate for cleft

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7
Q

Describe component of neonatal abdominal exam

A

Inspect and palpate for masses and discoloration
Check umbilical cord for erythema- oomphalitis
Quick feel
Check for liver and spleen, starting in RIF for both
- You can palpate liver and spleen in a normal neonate
Kidneys are low yield

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8
Q

Describe the components of the neonatal nappy area exam

A

Femoral pulses
Fingers into medial hip creases to part labia in girls
Boys- fingers right behind scrotum to check for testes, feeling down
Lift legs up to examine anus

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9
Q

Describe the components of the neonatal hip examination

A

Barlow and ortolani’s test

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10
Q

Describe barlow’s test

A

Can it dislocate?

Femur adducted, press down and out

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11
Q

Describe the ortolani test

A

Can the hip go back in?

Abduct femur, press in and up

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12
Q

Describe the limb exam for the neonate

A

Count and assess fingers and toes

Check for palmar creases (glyphs)- only one crease in down syndrome

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13
Q

Describe the components of the prone neonatal exam

A

Hold baby prone perpendicular to arm- does baby hold itself rigid for a couple of seconds? Indicates normal tone
Check for sacral dimple/tufts of hair/port wine stain- indicates possible spinal bifida occulta
Skin changes- peau d’orange, masses, rashes

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14
Q

Describe the neonatal reflexes to check

A

Grasp
Root
Suck
Pull to sit- hold baby forearms, lift up- at past 80 degrees head should fall forward
Moro- hold baby’s head in palm, drop arm down from 80-20 degrees quickly
- Normal response is symmetric arm abduction and extension, then back to midline
- Abnormal may suggest brachial plexus palsy (Erb’s/clumpkies) or clavicle plexus

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15
Q

Causes of acute abdominal pain

A 
IBD
Appendicitis
Henoch-Schonlein purpura
UTI
Constipation
Bowel obstruction
Gastroenteritis
Intussusception
Diabetes
Lower lobe pneumonia
Peptic Ulcer
Renal stone
Ovarian torsion/cyst/ectopic
Volvulus
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16
Q

Causes of recurrent abdominal pain (categories)

A 
Hepatitis
Gastrointestinal
Urinary
Pancreatitis
Gynaecological
Psychogenic
Abdo migraine
Sickle cell disease
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17
Q

Features of IBD on history

A

Acute abdo pain
Blood or mucus in stools
Weight loss and poor stools
FHx of diarrhoea

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18
Q

Features of acute apendicitis

A 
Acute abdo pain
Anorexia
Pain localises to RIF
Peritonism in RIF
Tachycardia
Low grade fever
Vomiting and diarrhoea
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19
Q

Features of Henoch-Schonlein purpura

A

Acute abdo pain
Purpuric rash on legs
Joint pain

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20
Q

Features of UTI on history

A 
Abdo pain
Dysuria and frequency
Bedwetting
Back pain
Vomiting
MSU/microscopy is positive
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21
Q

Features of constipation on history

A

Abdo pain
hard or infrequent stools
Mass in LIF
Faecal loading on radiograph

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22
Q

Features of intestinal obstruction on history

A

Abdo pain
Bile stained vomiting
Abdo distension
Consider volvulus

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23
Q

Features of gastroenteritis on history

A

Abdo pain

Vomiting and diarrhoea

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24
Q

Features of renal calculi on history

A

Abdo pain

Hydronephrosis

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25
Q

Features of peptic ulcer on history

A

Abdo pain
Pain at night
Relief with milk
Helicobacter pylori

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26
Q

Features of lower lobe pneumonia on history

A

Abdo pain
Signs of pneumonia
Referred abdominal pain

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27
Q

Features of diabetes on history

A

Abdo pain

Diabetic ketoacidosis

28
Q

Features of intussusception on history

A 
Abdo pain
Intermittent screaming/colic
Shock/pallor
Redcurrant jelly stool is a late sign
3-24mo old
Often following a viral infection
Palpable sausage shaped mass
29
Q

Ix for appendicitis

A

Bloods- leukocytosis, neutrophilia
Urine to exclude UTI
CT if in doubt

30
Q

Mx for appendicitis

A

Laparoscopic appendectomy
If perforation- may be adhesions etc.
ABX

31
Q

Ix for intussusception

A
  • Abdominal radiograph- may show proximal bowel obstruction, edge of intussusception against gas filled lumen
  • USS- Shows ‘donut sign’
32
Q

Mx for intussusception

A
  • Often reduced by air or barium enema

- If evidence of peritonitis- laparotomy

33
Q

Features of volvulus

A

Torsion of malrotated intestine
Severe abdo pain and bilious vomiting
Urgent surgery to untwist

34
Q

Mechanism of mesenteric adenitis

A

Enlarged mesenteric nodes cause acute pain but no peritonism or guarding

35
Q

Mx of mesenteric adenitis

A

Simple analgesia

36
Q

Types of chronic abdo pain due to GI causes

A 
IBS
Oesophagitis
Peptic ulcer
IBD
Constipation
Malabsorption
Giardiasis
37
Q

Types of chronic abdo pain from urinary tract

A

Lower UTI

Pyelonephritis

38
Q

Types of chronic abdo pain from gynaecological

A

Dysmenorrhoea
PID
Haematocolpos
Ovarian cyst

39
Q

Features of IBS

A

Recurrent abdo pain
Bloating
Altered bowel habit
May have alternating diarrhoea and constipation

40
Q

Dx of IBS

A

Symptoms must be present for 6mos

Requires an organic cause to be excluded

41
Q

Mx of IBS

A

Acute symptoms resolve
May need re-evaluation of diagnosis
Smooth muscle relaxants may help spasms

42
Q

Causes of vomiting

A 
Overfeeding
GORD
Pyloric stenosis
Whooping cough
SBO
Constipation
Systemic infection
Early pregnancy (older females)
Ingestion of toxins
Raised ICP
Migraine
Gastroenteritis
43
Q

Features of overfeeding causing vomiting

A

Feeding >200mL/kg/day

44
Q

Features of GORD causing vomiting

A

Due to lax GO sphincter and may see positional vomiting
May lead to oesophagitis or aspiration pneumonia
Can see apnoea or failure to thrive

45
Q

Features of pyloric stenosis causing vomiting

A 
4-6 weeks old
Projectile vomits after feeding
Hungry after vomiting
Less frequent stools
Palpable pyloric mass
46
Q

Features of whooping cough causing vomiting

A

Paroxysmal cough, red or blue colour change and then vomit

47
Q

Features of SBO causing vomiting

A

Bile stained vomit
Presents soon after birth
May show a distended abdomen

48
Q

Causes of diarrhoea in children

A 
Toddler's Diarrhoea
Nonspecific Diarrhoea
Cystic fibrosis
Coeliac disease
Secondary lactose intolerance
Overflow diarrhoea
UC
Lactose intolerance
Crohn's disease
Giardia
49
Q

Features of toddler’s diarrhoea on history

A
  • Thriving toddler
  • Loose stools containing undigested food
  • May have large fluid intake
  • Fast gut transit time
50
Q

Features of nonspecific diarrhoea on history

A

Loose watery stools

Thriving child, may follow after acute gastro

51
Q

Features of giardia infection

A

Weight loss and abdominal pain
Watery stools
Common in nurseries

52
Q

Features of crohn’s disease on history

A

Late childhood/adolescence
Weight loss and abdominal pain
Anorexia and fatigue
Exacerbations and remissions

53
Q

Features of cows milk protein intolerance

A

Occurs in babies
Watery stools that may be bloody
May also show urticaria, stridor, bronchospasm or eczema

54
Q

Features of UC on history

A

Late childhood and adolescence
Bloody stools and abdominal pain
Exacerbations and remission

55
Q

Features of overflow diarrhoea in constipation

A

Soiling rather than diarrhoea

Constipated stool may be palpable abdominally or rectally

56
Q

Features of secondary lactose intolerance on history

A

Baby or toddler
Follows acute gastro
Watery stools with low pH and reducing substances

57
Q

Features of coeliac disease on history

A

Failure to thrive with irritability, muscle wasting, abdo distension
Often presents after introduction of wheat into diet
Fatty stools
Diagnosed on jejunal biopsy

58
Q

Features of cystic fibrosis on history

A

Starts in infancy
Failure to thrive with chest infections
Fatty stools
Diagnosed with sweat test

59
Q

Mx of secondary lactose intolerance

A

Empirical formula change to soy or lactose free milk

Revert to cows milk after symptom resolution

60
Q

Ix for coeliac disease

A

Iron deficiency anaemia
Steatorrhea
IgA tTGA2 present in blood
Definitive diagnosis with villous atrophy on jejunal biopsy

61
Q

Mx of coeliac disease

A

Gluten free diet indefinitely

Repeat challenge and biopsy at 2 years

62
Q

Assoc with coeliac disease

A

Diabetes

Down syndrome

63
Q

Dx of crohns disease

A

Endoscopic biopsy

64
Q

Mx of crohns disease

A 
Elemental diet
Immunodulator drugs
Anti- TNF-a (infliximab)
Steroids
Surgical resection if localised
65
Q

Mx of UC

A

Oral or rectal mesalazine or steroid enemas

May require immunosuppression, infliximab or colectomy if severe

66
Q

Dx of giardia

A

Microscopic stool examination over 3 seperate specimens

May also have eosinophilia on bloods

67
Q

Mx of giardia

A

Metronidazole

Clinical Medicine (5 decks)

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