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KFP study > Paediatrics- general, MSK, surgical > Flashcards

Paediatrics- general, MSK, surgical Flashcards

1
Q

What are red flags for neonatal jaundice?

(4)

A

Jaundice within the first 24 hours

Or Jaundice > 2 weeks

Unwell/febrile child

Dark urine and pale stools (biliary obstruction)

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2
Q

What are causes for paediatric haematuria?

A

Commonly
Viral infections
UTI
Trauma

Glomerular causes:
Post streptococcus Glomerulonephritis
HSP
ITP
IgA nephropathy
Basement membrane disease

Less common
HUS
SLE

Neoplastic. like a Wilms tumour

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3
Q

If a child presents with Haematuria, what are red flag features that would make you consult a paediatrician?

A
  1. Proteinuria
  2. Hypertension
  3. Fluid Overload (oedema or ascities)
  4. Immunocompromise
  5. Flank or abdominal pain
  6. Systemically unwell
  7. Abdominal Mass.
  8. Microscopic haematuria Not resolving after 3 consecutive tests
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4
Q

What causes an IgA nephropathy?
How is it different from post-streptococcous glomerulonephropathy?

A
  1. Caused by an immune complex deposition in the Glomerular mesangium. These are activated usually due to a crossreactivity after a viral URTI.
    For some reason these IgA complexes cannot be cleared by the Liver and end up deposited in the kidney.
  2. Post infectious glomerulonephritis usually occurs 4-6 weeks after an infection, whereas IgA nephropathy is within days. PSGN is usually caused by complement activation not Ig’X’ deposition
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5
Q

In a neonate what are 5 causes of abdominal pain and which are time critical?

A

Time critical:
-Hirschprung enterocolitis
-Necrotising Enterocolitis
-Volvulus
-Incarcerated hernia

Less time critical
-Intussussception

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6
Q

Examination components of a child with abdominal pain?

(3) components
list features under each

A

General inspection - Assess movement, gait, position and level of comfort

Specific to abdomen
-Focal vs. generalised tenderness
-Rebound tenderness
-Guarding or rigidity
-Abdominal Masses
-Distention
-Palpable faeces

in room tests
Non abdominal causes
- finger prick BGL for DKA (not technically an ‘exam.)

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7
Q

Time critical causes of abdominal pain in children and adolescents?

(6)

A

Volvulus
Torsion (testicular or ovarian)
Incarcerated hernia
Meckels Diverticulum
Intussusception
Abdominal trauma

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8
Q

Red flag features of a cough in a child?

A

Associated with choking
Associated with feeds
Poor growth
Loss of muscle or fat stores
Abnormal Cardiac examination
Clubbing
Differential air entry

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9
Q

When should you suspect Kawasaki Disease?

A

Ages 6 months to 4 years old

Prolonged fever without explanation
(>5 days)

Extreme irritability with the fever

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10
Q

Diagnostic criteria for Kawasaki disease?

A

5 days of fever plus

4 of the 5 following features
1. Conjunctival injection
2. Oral changes (strawberry tongue)
3. Rash (erythematous polymorphous rash)
4. Extremity Changes (Oedma or desquamation)
5 Lymphadenopathy (unilateral with 1 at least >1.5cm)

“COREL”

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11
Q

How do you manage Osgood Schlatter disease?

A
  1. Reassurance that the condition is self limiting
  2. Modify activities to manage the pain
  3. Local measures: ice pack application
  4. Quadriceps stretching, There is a fact sheet from the RCH
  5. Anti-inflammatory medications
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12
Q

Cervical Lymphadenopathy in a child can be found in a _(proportion)____ of healthy children …

Cervical lymphadenopathy may last for _______ to _______.

Abnormal lymphadenopathy is at the size of _____ .

A

third

weeks (to)
months

> 1cm

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13
Q

What are red flag features on history and exam for a set of enlarged lymph nodes?

A

fevers
night sweats
bruising
Deep tissue features: lock jaw (trismus) or muffled voice

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14
Q

What is bacterial lymphadenitis?

What does it present like?

What to be ware off?

A

Usually unilateral lymph nodes infected by bacteria such as staphylococcus aureus.

Apart from the enlarged LN, fevers, night sweats, neck pain

Someimes bacterial lymphadenitis is associated with a retropharyngeal abscess, and it might pay off to image these children.

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15
Q

Initial blood tests to order if cervical lymphadenopathy lasts 2-6 weeks

(7)

A

CRP, ESR

LDH

FBC

Serology of various pathogens: EBV, CMV, HIV

Tuberculin skin test

Neck U/S

CXR if malignancy suspected (painless, firm lumps, systemic features, hepatosplenomegaly, easy bruising)

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16
Q

What are red flags with regard to a paediatric limp?

(6)

A
  1. > 7 days
  2. severe localised joint pain (?septic arthritis)
  3. Nocturnal pain and symptoms
  4. Systemic symptoms: fever, weight loss, fatigue, lethargy
  5. Change in bowel or urine habits
  6. Complete inability to walk or weight bear
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17
Q

Common causes of limp in 0-4 year olds?

(4)

A

Transient hip synovitis

Acute myositis

Toddler’s Fracture

Developmental dysplasia of the hip

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18
Q

Common causes of a limp 5-10 years?

(4)

A

Transient hip synovitis

Acute myositis

Developmental dysplasia of the hip

Perthe’s disease

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19
Q

Common causes of a limp in children >10?

A
  1. stress fractures and pains
  2. Traction apopysitis (osgood schlatter, severs)
  3. SUFE - slipped upper femoral epiphysis
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20
Q

Examination red flags in a child with a limp? (4)

A

Fever

Ecchymosis/ purpura / petechiae

Generalised wasting

Not weight bearing

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21
Q

What investigations can be offered when a child

a. has no red flags in the history or exam
b. is ambulating with minimal discomfort or no discomfort (using analgesia)
c. and there is a clear workable diagnosis and a follow up plan in (_x___) days ?

Answer question and fill in the x

A

No investigations necessary

x = 7
(follow up in 7 days)

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22
Q

What is the tell sign of a child that presents with this?

what should you investigate this with specifically?

A

This is a SUFE (slipped upper femoral epiphysis)

Sign is Obligatory external rotation of the hip during flexion

Investigate with a AP and frog lateral pelvis XRAYS of both hips.

23
Q

Who do SUFE’s usually occur in?

A

Adolescents

Boys (60%)

Overweight and obese individuals

24
Q

What advice to give parents about a SUFE? including what treatment and what can be longer term complications?

A

Needs surgical correction to stabilise the hip.
It does need urgent orthopaedic assessment

Osteonecrosis 50% risk even if stabilised

Chrondrolysis - due to slipped pin from stabilisation

Early onset osteoarthritis

Impingement -after SUFE is stable and healed –> acetabular impingement , may need further surgery

25
Q

What is Perthes Disease?

Who does it occur in?

How does it present?

What are initial steps to take? (3)

A
  1. when blood supply to the femoral head is interrupted and bone begins to die
  2. usually hyperactive boys ages 4-10
  3. Pain with activity- in hip, thigh or knee, variable limp, loss of hip motion
  4. Urgent referral to orthopaedics
    Plan XRAY AP and FROG
    Analgesia - paracetamol, NSAIDs
26
Q

What is this illustration trying to show?

A

Sever’s Disease

Pain is located near the achilles tendon attachment to the heel. During periods of rapid growth there may be a discrepancy in the growth rates of long bones, muscles and tendons resulting in increased tension across the growth plate causing heel pain.

No ‘cure’

27
Q

Management of Sever’s disease?

(5)

A
  1. Activity Modification
  2. Ice packs for symptoms
  3. Appropriate sport shoes/ gel pads
  4. Daily stretching before and after sport
  5. Education it can take 6-12 months to resolve.
28
Q

Broad causes of a paediatric limp, including causes not be missed?

A
  1. infectious/post infectious causes
    most important: septic arthritis
    other: transient synovitis, or myositis (usually post influenza)
  2. Fractures
    most important: growth plate injuries, non-accidental fractures
  3. SUFE
  4. Perthes disease
  5. Growing related pains
    osgood schlatter
    severs disease
  6. neoplasm/mass
  7. Non accidental (apart from fractures) causes
  8. non infective arthritis
    Juvenille Idiopathic arthritis

https://www.rch.org.au/clinicalguide/guideline_index/Child_with_limp/

29
Q

A child aged 8 presents with various sore joints over the course of a 8 months. She also complains of morning stiffness, difficulty carrying her school belongings and being constantly tired.

There is no history of illnesses or infections and no medications, allergies or concerns about trauma or mental/family well being. She has been tracking on 65th percentile consistently, no dietary concerns. She is not overweight/obese.

What is the likely diagnosis and what can be done to treat this?

A

Juvenille Idiopathic Arthritis.
Which is an autoimmune arthritis. There are subtypes.

Patients can use NSAIDs initially or prednisolone for flare ups, but will essentially need DMARDS or bDMARDS initiated by specialist teams. Depending on the subtype there may be other therapies. e.g. joint steroid injections.

30
Q

HEADBUMPS stands for?

A

Following head injury this is what parents should watch out for?

31
Q

Is loss of consciousness needed to define what a concussion is?

A

No.

Concussion is defined as a mild form of traumatic brain injury that occurs after a direct impact to the head causing force transmission to the brain.

32
Q

Main cause of croup?

A

Parainfluenza virus

33
Q

Patients with croup may have a fever with their stridor. However if there are other systemic signs present other diagnoses should be considered.
Such as?

(5)

A

bacterial tracheitis

acute epiglottitis

acute tonsillitis or pharyngitis

retropharyngeal abscess

foreign body inhalation

34
Q

What is non drug management for croup?

(6)

A

1 Minimise handling to avoid worsening symptoms
2 Keeping the child with parent/carers to minimise distress
3. keep child calm, watching TV or reading
4. Allow child to adopt their own position of comfort
5. Reassuring and educating parents on the cause
6. Provide carer information sheet

35
Q

medical treatment for croup (mild-moderate)

A

Prednisolone 1mg/kg (up to 50mg) orally as a single dose, stat

OR

dexamethasone 0.15mg/kg (up to 12mg) orally as a single dose

IF
oral steroids are not indicated consider budesonide 2mg by inhalation via nebuliser, repeating every 12 hours for 48 hours PRN.

AND for all

Observe for 30 minutes after administration

36
Q

How common is daytime urinary incontinence in children?

How common is nocturnal eneuresis by 5 years old?

A
  1. 17-20%
  2. 8-20%
37
Q

What age are most children continent of urine?

A

About 4 years old, but it can still be normal to be incontinent at this time.

38
Q

Overactive bladder is a common disorder of urinary __(a)__ and commonly presents with urgency, frequency and urge incontinence. These children have small volume voids during the day.

Children with infrequent voiding (less than four voids per day) may have voiding __(b)___. This may present with urgency and __(c)__ _____. Some of these children have ___(d)____ problems.

A

a. storage

b. postponement

c. holding postures

d. behavioural

39
Q

Nocturnal enuresis without other lower urinary tract symptoms (monosymptomatic nocturnal enuresis) is more common than enuresis with lower urinary tract symptoms (non-monosymptomatic nocturnal enuresis). Enuresis is also classified as primary or secondary.

What is the definition of primary vs. secondary?

A

primary- never achieved continence

secondary- previously achieved continence for at least 6 months

40
Q

Conservative therapy (also known as ‘urotherapy’) is non-surgical, non-pharmacological treatment for lower urinary tract symptoms and should be used in all children with urinary incontinence. It includes:

(4)

A
  1. Education and advice about regular voiding and correct voiding posture
  2. avoid holding manoeuvres
  3. encouraging adequate fluid intake
  4. Treating constipation

In one study, treatment of constipated children with a bowel program resolved daytime incontinence in 89% of cases, enuresis in 63% of cases and urinary tract infections in 100% of cases

41
Q

A. What is the one first line therapy for nocturnal enuresis?

B. What is the biggest factor that determines success of this therapy?

A

A. Alarm training is the first-line therapy for nocturnal enuresis and the most effective long-term treatment.

extra info…
Enuresis alarms are wetness sensors which sound and wake the child when wet. They are either placed under the bed sheets (‘bell and pad’ or bed alarms) or worn in the child’s underpants (‘body worn’ or personal alarms).

It can take weeks to work. And should be continued until 14 consecutive dry days are reached. Early cessation can lead to recurrence.

B. The biggest factor is motivation to adhere to the regime from both child and parent.

42
Q

Which medications can be considered for treatment of enuresis in children?

List in order of evidence/appropriateness.

A
  1. Desmopresin. Pretty much is synthetic ADH/AVP. can resolve up to 70% of cases. need to limit fluid intake at night otherwise can end up with water overload as this is ANTI diurectic. Also then low sodium.
  2. Anticholinergics like oxybutynin. Best use in combination with alarm therapy.
    Solifenacin is a new bladder specific medication. less evidence in paediatrics however.
  3. TCAs. for specialist use really.
43
Q

Children with eneuresis require a referral if they have…?

(4)

A
  1. severe day time symptoms
  2. physical or neurological problems
  3. recurrent urinary tract infections.
  4. Psychosocial co-morbidities.
44
Q

what are red flags regarding the penis/foreskin ?

(3)

A
  1. urinary retention
  2. Red penis with a fever
  3. blue/black distal penis
45
Q

Foreskins can take some time to fully retract, what is the normal rate of foreskin reaction at 3 key ages?

A
  1. 10% of boys at 1 year
  2. 50% of boys at 10 years
  3. 99% of boys at 17 years

A non-retractable foreskin is a normal variant and does not need intervention

46
Q

What is smega, is it normal?

A

Before the foreskin becomes separate and retractable, it is common for smegma to collect in small yellow/white lumps which may be visible or palpable through the foreskin. These are normal, and need no intervention

47
Q

What is balanitis?

How to manage it?

(6)

A

Part A
Balanitis is inflammation of the glans penis

Part B
Soaking in warm salt water settles swelling and discomfort

Barrier or 1% hydrocortisone cream (see also Nappy rash)

Antifungal cream (clotrimazole, miconazole) if candida suspected

Oral analgesia may be needed

Topical antibiotic ointments and creams are not efficacious

Preputial retraction during acute inflammation should not be recommended as this can lead to paraphimosis

48
Q

What is phimosis?

What is potential treatment?

What is the biggest conern?

A

A. Inability of the foreskin to retract. Pathologic phimosis results from scarring of the preputial ring preventing retraction. This is distinct from normal non-retractable foreskin described above.

B. Application of topical steroid cream (0.05% betamethasone cream 2-3 times daily) should be trialled for 2-4 weeks

If good response to steroids, continue for total of 6-12 weeks

If no / poor response to steroids, pathologic phimosis is likely. Refer to Urology services

C. Red flag: urgent surgical referral is required is the child is unable to pass urine

49
Q

What is paraphimosis?

What should be done?

A

Paraphimosis occurs when the foreskin is left in the retracted position. The foreskin distal to the tight area becomes oedematous which makes it difficult to reduce the foreskin over the glans

Paraphimosis is a urological emergency and brings a risk of preputial necrosis

50
Q

5 steps to treatment of paraphimosis?

A

Give oral analgesia and reassurance

Wrap a firm compression bandage (ideally 1 inch, for example Coban, pictured) over the oedematous area, starting at penile tip

Leave bandage for 10-15 minutes (use a timer)

Remove bandage and attempt to reduce foreskin over the glans. If unsuccessful, repeat bandage for further 15 minutes and re-attempt

If manual reduction fails, obtain urgent surgical consult

51
Q

What are potential benefits of circumcision?

A
  1. Can prevent urinary tract infections esp in the first year of life
  2. Can prevent infections developing under the foreskin during childhood
  3. Eliminates the risk of developing penile cancer later in life, however that is extremely rare to begin with (1/250000).
  4. In countries with higher rates of syphilis and HIV it can reduce the man catching the disease. However in Aus/NZ where these diseases are rare, there is no significant difference.

Keep in mind circumcision can be put off until the child is old enough to understand the risks and benefits, and make the decision for themselves.

52
Q

what are the two normal variants in growth of a child?

A
  1. Constitutional / maturation delay
  2. Familial short stature
53
Q

What are causes for short stature?

Endocrine PICNICS

A
  1. Endocrine: hypothyroidism, GH deficiency, Cushings syndrome
  2. Psychosocial - deprivation- slows GH
  3. Chronic illness: e.g. coeliac, other bowel disease, renal disease, haematological disease
  4. Nutritional: deprviation
  5. Intrauterine growth retardation causing a syndrome of some kind
  6. Chromosomal
  7. Skeletal dysplasia.

KFP study (31 decks)

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