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Phase 3a > Paediatrics part 2 > Flashcards

Paediatrics part 2 Flashcards

1
Q

What is wheeze?

A

A physical sign, whistling sounds on expiration and polyphonic

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2
Q

why is a wheeze expiratory?

A

In intra thoracic pressure to increase and causes the airways to constrict more

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3
Q

Why is a wheeze polyphonic?

A

Different sized airways are affected

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4
Q

What can cause wheeze in children?

A

Viral episodic wheeze, asthma, persitent infantile wheeze plus others ( CF, Thracheo-bronchomalacia, Cilliary dyskinesia, GORD, chronic aspiration immune deficiency persistent bacterial bronchitis, Chronic lung disean of the newborn)

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5
Q

What age does asthma usually present from?

A

From the age of 5

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6
Q

What are the symptoms viral episodic wheeze?

A

No interval symptoms, no excess of atopy, likely to improve with age. No benefit from inhaled steroids, may use oral steroids

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7
Q

What are the causes of wheeze pathophysiologically?

A

Inflammation and oedema of the airway, excess mucous, infection

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8
Q

What is acute asthma managment?

A

Oxygen if needed bronchodilator, Salbutamol maybe nebuliser, atrovent (ipatropium bromide), prednisilone 1mg/kg if asthma maybe Dexamthasone, Maybe IV steroids hydrocortisone, IV salbutamol bolus, Aminophylline MgSO4 salbutamol infusion

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9
Q

What is aminophylline?

A

Respiratory stimulent and respiratory dilator, low therapeutic idex

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10
Q

What is the principle of steroid drug ?

A

Minimum oral dose, minimum effective dose

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11
Q

What are reasons for failure of asthma treatment?

A

Adherence, diagnosis, environment choice of drugs/devices, bad disease

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12
Q

What are the side effects of inhaled steroids?

A

Adrenal supression - dose relates surpression, only 28 cases of adrenal crisis in children on inhaled steroids high doses have impaired adrenal axis
Growth reduction?- yes over 2 years reduce it by 1cm, affects final growth probably
Bones- dose related reduction in mineralised bone density but unlikely to cause fractures

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13
Q

How to balance risks of ICS?

A

Minimise dose and maximise targeting, monitor growth and discuss with the family

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14
Q

What are upper resp infections?

A

rhinitis, otititis media, pharengitis, tonsilitis larygitis

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15
Q

What are lower resp infections?

A

bronchitis, croupd, epiglottitis, thraceitis, bronchiolitis, pneumonia

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16
Q

Which resp infections are mainly viral?

A

Rhitistis, pharengitis laryngitis croupd bronchiolitis

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17
Q

Which pathology causes tahypnoea?

A

Ones that affect alveoli or respiratory bronchioles affecting gaseous exchange

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18
Q

What is the most common respiratory virus in children?

A

Respiratory syncytial virus

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19
Q

How do viral infetions tend to progress?

A

They begin in mouth or nose and progress down the airways

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20
Q

What can be presentation of respiratory virus?

A

Croup Pneumonia viral exacerbation of asthma, wheezy bronchitis, bronchiolitis all can present in all ways but certain viruses are more likely to present in certain forms

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21
Q

What can cause acute stridor?

A

Croup and acut epiglotittis

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22
Q

What are viruses that cause croup?

A

Usually para flu

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23
Q

What is croup treatment?

A

Steroids single dose to reduce inflammation

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24
Q

What is the cause and treatment of Acute epiglottitis?

A

Haemophilus influenzae B usually, try to not upset the child, secure airway, anaesthetist, or ENT surgeon.

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25
Q

What are red flags for epiglottitis?

A

Stridor, Drooling, no barking cough, might posture to open airway,

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26
Q

What cause bronchitis?

A

Moroxella cotaris, haemophilus non B type, and pneumococcal they create biofilms, it doesnt cause tachypnoea, chronic cough,

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27
Q

What is the problem with bronchitis?

A

Chronic can cause bronchiectasis through dammage to the airways

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28
Q

What is treatment for bronchitis?

A

Augmentin treated for 21 days and let airways heal

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29
Q

What are DSM-V ADHD criteria?

A

6/9 Inattentive characteristics, 6/9 Hyperactive/Impulsice symptoms present before 12 years developmentally inappropriate several symptoms in 2 or more settings, clear evidence symptoms interfere/reduce quality of social/academic/ occupational function

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30
Q

What are risk factors for ADHD?

A

Preterm, ODD/CD, mood idosrders faily with ADHD, epilepsy neurodevelmpental conditions aquired brain injury,

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31
Q

What causes ADHD?

A

Genetics, Environmental factors, CNS insults Neuroanatomic neurochemical

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32
Q

What are the areas ASD can present?

A

social communication and repetitive braviour and sensory interests

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33
Q

What are ASD communication difficulties?

A

Strange use f accents, poor non verbal communication gestrure body language, reciprocity, pedantic language very literal dont get idioms and jokes,

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34
Q

What are the ASD social interactions?

A

no desire to interact with others no understanding of social rules, dont understand interactions

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35
Q

How does rigid thinking with ASD present?

A

Imagination play cant do , using toys as objects, rules are fixed, dont like change playing the same games

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36
Q

How to differentiate OCD from ASD with fixation?

A

OCD don’t like the obsesion ASD enjoys it

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37
Q

When is ASD diagnosed?

A

When it causes a problem in their lives

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38
Q

What causes osteogenesis imperfecta?

A

Disease of collagen deposition where have the wrong ratio of collagen to minerals

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39
Q

What are the features of Osteogenesis imperfecta?

A

Collapse of axial skeleton bones, short long bones of the body. brittle bone less bone trabecular bone is compressed, bone fragility bone pain impared mobility poor growth deafness

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40
Q

What are symproms of OI?

A

vertebral crush fractures long bone fracturs

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41
Q

What are the grades of osteogenesis imperfecta?

A

Type 1 low grade only get one every year or two
Type 2 lethal
Type 3 proressively deforming
Type 4 moderate

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42
Q

What are causes of osteoporosi in children?

A 
Inherited/congenital:
Osteogenesis imperfecta
Inborn errors eg galactosemia
Hematological problems
Idiopathic
Acquired:
Drug-induced - especially steroids
Major endocrinopathies
Malabsorption
Immobilisation
Inflammation
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43
Q

Who is involved in management of Osteogenesis imperfecta?

A

physition bone targeting drugs, pain associated medical problems, Surgeon long bones spine skull base hearing teeth, therapists muscle strength/mobility social and education

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44
Q

What are the main treatments for OI?

A

Bisphosphonate, work well in kids to help increase bone mass but isnt better bone quality

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45
Q

What are the effects of Bisphosphonates on outcomes?

A

Reduced fracture frequency, Increased vertebral height, supressed bone markers, reduced pain, increased overal mobility, no aderse effect on growth

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46
Q

What is rickets?

A

Deficiency in Vitamin D from lack of sunlight and poor nutrition.

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47
Q

What is the process of activation of vitamin D?

A

D3 cholecaliferol is converted to 25OH vit D in liver then 1,25(OH)2 vit D in kidney

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48
Q

What does vitamin D do?

A

Makes calcium more available, increases absorption from the guy increases calcium release from bone. It as a role in immune function and tolerance

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49
Q

What are ideal levels of Vit D?

A

75 nmol/L but not clear how much this is true

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50
Q

What is presentation of rickets in early life?

A

Hypocalcaemia

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51
Q

What are presentation of low vitamin D?

A

Bowed legs, hypocalcaemic convulsions, gross motor delay, incidnctal x ray findings swollen ankle carpo,pedal spasm

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52
Q

What are the dangers of severe vit D deficiency?

A

Cardiomyopatht, hypocalceamic convulsions

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53
Q

What is the pinna made from embryology?

A

6 Hillocks of his mesoderm 1st and 2nd branchial arches

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54
Q

What is emryolocically important about tympanic membrane?

A

Made of all 3 laters

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55
Q

What is microtia?

A

Poorly formedd ear

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56
Q

What are congenital problems with ear?

A

Absence of auricle/ microtia
Atresia of outer ear canal
Pre auricular sinus
Accessory auricles
Prominent ears
Outer ear abnormalities may herald middle ear problems
Inner ear develops earlier than middle/outer ear

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57
Q

What is important about outer ear problems?

A

Might have a middle ear problem but unlikelly to have inner ear problem

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58
Q

What are the syndrome with ear pits?

A

branchio- oto- renal syndrome

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59
Q

What are the middle ear issues?

A

Abnormal ossibles disrupts conduction, craniofacial syndromes

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60
Q

What are risk factors for earing problems?

A

Maternal drugs, family history, Prematurity Jaundice Anatomical abnormalities

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61
Q

What is otitis externa?

A

Painful inflammed EAM Pinna treat with microsucction topical antibiotics

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62
Q

What is otitis media?

A

Glue ear infection eustatacian tube dusfunction, fluid in middle ear can be painless self limiting but risks of complications mastoiditis,

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63
Q

What could happen with chromic ititis media?

A

Cholesteatoma

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64
Q

What is treatment for otitis media?

A

Conservatice do nothing eustachian tube autoinflation, ventilation tubes Grommit, hearing aids alternative to surgical intervention where it is

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65
Q

What is cause of cronically discharging ear?

A

Perforation, retraction pockets, chronic supparative otitis media, cholesteatoma

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66
Q

What is a cholesteatoma?

A

Chronic infections, repeated infections offensive discharge can see perforation, causes chronic discharge

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67
Q

What are the structture of the ear drum?

A

Mesoderm is missing from top section making it weaker

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68
Q

Why are cholesteatomas important?

A

Damage to middle ear inner ear structures, ossicles and facial nerve

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69
Q

How do you treat choleseatoma?

A

Dry safe ear, perforation close it, remove it if you can preserve it

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70
Q

What is acute mastoiditis?

A

Boggy swelling behind ear, acute mastoiditis is a paediatric emergency, itsan abscess

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71
Q

What are ear foreign bodies treatment?

A

Try to get it out if you can then call ent if not possible

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72
Q

What are nasal problems in babies?

A

They are obligate nasal breathers so they need it to be patent

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73
Q

What is choanal atresia?

A

blockage at the back of the nose septim not working

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74
Q

What can cause craniofacial abnormalities?

A

syndromic, down apert pfeiffer crouzon treacher collins, May have problems with airway, OSA midfacial hypoplasia,

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75
Q

What is signs and symptoms of nasal foreing body?

A

Single sided foul discharge or blood

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76
Q

What is treatment of nose bleeds?

A

Stop nose picking, cut nails, remove antimicrobials, topical naseptin silver nitrate cutery surgical treatment electrocautery

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77
Q

What is an issue with unilateral heavy nosebleeds in boys unprovoked?

A

Nasopharengel angiofibroma

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78
Q

What is asscoiated with natal polyps?

A

Cystic fibrosis

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79
Q

What is the smallest part of child throat?

A

Subglottis so can get stuck below the vocal chords

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80
Q

What is laryngomalacia?

A

stridor worse on feeding and exertion worse when supine only if failure to thrive and increased WOB

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81
Q

What is sleep apneoa in kids?

A

Not to do with obesity, tensils and adenoids Obstructive sleep apneoa

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82
Q

What is hostory of sleep apnoea?

A

Snoring with period breaks

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83
Q

What are common asthma triggers?

A

Common cold, exercise, emotions stress smoking, pollution, pet/animal allergy, pilen house dust mite, weather changes moulds perfumes aerosols

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84
Q

What age do you do lung function test for asthma?

A

After 5 years

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85
Q

What is complete control of asthma?

A

No need for relieve, no datime symptoms no night awakening no exacerbations nolimitations on life

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86
Q

When do you use a spacer?

A

Always in children

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87
Q

What colours of spacers are there and who are they form?

A

Orange premature babies, yellow 1 to 4 years, 4 and above Volumatic spacer clear or green

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88
Q

What is the complication of malrotation?

A

bowel ischaemia,

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89
Q

What colour vomiting is pyloric stenosis?

A

Milky as bile cant get past it

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90
Q

What is bilestained vomiting?

A

Green vomiting

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91
Q

When is pyloric stenosis most likely to occur?

A

4 weeks

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92
Q

When is malrotation likely to present?

A

in the first 24 hours

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93
Q

What can cause bile vomitting?

A

Sepsis and malroation

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94
Q

What is gold standard investigation for malrotation?

A

NG upper GI with contrast xray

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95
Q

What is examination findings in pyloric stenosis?

A

feeling olive sized lump that is the sphincter, abdominal distension may see peristalsis

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96
Q

How to image pyloric stenosis?

A

Ultrasound

97
Q

What blood resulsta are likely in pyloric stenosis?

A

Hypokalaemic, hyponatraemic (may get artificial rise from dehydration), Hypochloraemia, hypochloraemic, high pH Base excess becomes more positive
Hypochloraemic metabolic alkalosis

98
Q

What causes low potassium in vomitting?

A

Lose Hydrogen ions causing alkalosis, potassium hydrogen exchanger in kidneys tries to correct it.

99
Q

What can act as lead points for interssuception?

A

Meckles diverticulum, bowel tumours, peyers patch (ideopathic)

100
Q

What are the triad of symptoms for interssuception?

A

crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools

101
Q

What are most common causes of acute abdominal pain?

A

Non-specific, appendicitis

102
Q

What is guarding?

A

Tense abdominal muscles. can be voluntary or involuntary. Involuntary is important, as indicates peritonitis

103
Q

What is the best symptoms for appendicitis?

A 
M igration of pain
A norexia
G uarding
N ausea
E levated temperature
T enderness in RIF
104
Q

What can cause vomiting physiologically?

A

Toxic material in lumen, visceral pathology, vestribular disturbance cns disturbance

105
Q

What are the important questions for vomiting?

A

ilious or non-billious vomiting, bloody or non-blody, projectile no-projectile age of presentation, febrile afebrile, nausea abdo pain distension diarrhoes and constipation, headache, changes in vision polyuria polydipsia weifht losss

106
Q

What are red flags for vomiting?

A

Meningism, costovertebral tenderness abdominal pain

107
Q

What diseases are the changes in common pathology for vomiting?

A

Mostly surgical early on then, more infectious or inflammatory

108
Q

What are the consequences of vomiting?

A

Hypo kaleamic chloraemic alcalosis, nutritional issues can cause mallory-weis tear, tears of oesophagus, dental caries, oesophageas stricutre barrett’s metaplasia broncho-pulmonary aspiration, Anaemia

109
Q

What are the antiemetics?

A

Antihistamine H1 receptore, dopamine antagonist procholrperazine D2, serotonin antagonist ondansteron 5HT-3, steroid Dexametason, Neurokinin receptor antagonist

110
Q

How common is reflux?

A

Most t - 4 monts have it, 41% 3-4 months possset after 1.5 years its much lower

111
Q

What is history of GORD in infants?

A

Faltering growth, Oesophagitis stricture, Apoea, Wha aspiration wheezing hoarsness Iron deficiency aneamia, Seizure- like events

112
Q

What are the investigation for GORD?

A

pH study, Barium swallow and meal endoscopy, Impedence study, picks up acid and others

113
Q

How can you manage GORD?

A

Feeding position, Thicken feeds, Change feeds, Drugs antacid H2 blocker PPI, Surgery, fundoplication ( tighening the upper sphincter

114
Q

what is carabel?

A

Thickener

115
Q

What are the risk factors for GORD?

A

prematurity, others

116
Q

What is an allergy versus intollerance?

A

Allergy is immune mediated. thre are IgE mediated non IgE and mixed cell mediated

117
Q

What acre cows milk protein allergy?

A

Caseins whey proteins in cows milk causes vomitting possibly with dairy (2-7.5% prevalence) it is more than one system, Skin, resp and gastro

118
Q

What are resp symptoms for cows milk protein allergeis?

A

Wheezy nasal itching sneezing rhinorrhoea or congestion

119
Q

What is management of CMPA?

A

elemination of diet, hyrolysed or amino acid feeds

120
Q

What is lactose intolerance in children?

A

lactase apears late in foetal life and falls after 3 years, unlikely to be primary, late onset common in oriental background,

121
Q

What are the lactose intollerance in children symptoms?

A

Explosive watery stools, abdominal distension, flatulence audible bowel sounds.

122
Q

What are tests for lactose intollerance?

A

Small bowel biopsy, yrogen breath test elimination diet

123
Q

What is Encopresis?

A

Involuntart fecal soiling or incontinence secondary to chronic constipation

124
Q

What are the symptoms of constipation for diagnosis?

A

Two or fewer defecatons per week, at least one episode of faecal incontinence retentive posturing or stool mass

125
Q

What causes constipation?

A

Posssibly a cycle of painful defactation voluntary withholding causes harder stools leading to more pain, then cycles roung

126
Q

What are red flags with constipation?

A

delayed passage of meconium, fever vomitting bloody diarrhoea, failure to thrive, tight empty recti, wot presence of palpable abdominal faecal masss, abnormal neurological exam

127
Q

What are causes of constipation differentials?

A

Hirshsprung’s disease, anorectal intestinall dysplasia, spina bifida, neuromuscular disease hypothyrodi, hyper calceamia coelica disease medications

128
Q

What are long term complications of constipation?

A

Megacolon, anal fissures overflow incontincence behavioural problems

129
Q

When to perform stool microbiology?

A

bloody mucous, suspect sepsis, foreignt travel child is immunocompromised

130
Q

When to treat diarrhoea with antibiotics?

A

if bacterial GE complicated by cepticaemia or systemaic infections or malnourisehd

131
Q

What is hypernatreaemic dehydration?

A

Unusual but serious irribible, water shifts from intracellular to extracellular, rehydration should be slow

132
Q

What does faecal calprotectin test for?

A

Inflammation

133
Q

What are the treatments for crohn’s diasease?

A

special diet can be as good as steroids,

134
Q

When is surfactant and alveoli usually made?

A

after 24 weeks alveoli increase surfactant increases after a while

135
Q

What is chronic lung disease of prematurity?

A

officially needing oygen at 36 weeks corrected age, reduced lung volume, reduces alveolar surface diffucsion defect

136
Q

When is the brainstem fully myelinated?

A

32 to 34 weeks

137
Q

What is the implications of brainstem non myelination?

A

transient apnoea of the newborn, also bradycardia

138
Q

What is used to treat apnoea in preterm?

A

caffeine

139
Q

Why are ventricular bleeding bad in neonates?

A

Become hypovolaemic, and hypoperfusion of the brain

140
Q

What does the umbilical vein go to?

A

Ductus venosis, to inferior vena cava

141
Q

What happens at birth to a foeatus circulation?

A

resistance in lungs increases, causing FO to close and ductus arteriosis closes to stop the shunt to the lungs.

142
Q

What are the three categories of congenital heart disease?

A

Narrowings, holes and conections, or complex

Duct dependant or non dependant or cyanotic or not

143
Q

What is most common defect?

A

VSD 3-4/1000 ;eft to right shunt causes increasd flow to lungs most close on their onwn

144
Q

What is the signs of VSD?

A

Pansystolic mumer on loudest on left lower sternal edge can have thrill gallop rhythm. can have tachypnoea, poor feeding failure to thrive

145
Q

What are the problems with ASD?

A

Left to right shunting increased blood to lungs, low velocity shunt usually not murmur so get pulmonary flow murmur, can cause arrhythmias in early adult hood

146
Q

What are signs of ASD?

A

Pulmonary flow murmur, fixed splitting of S2

147
Q

What is AVSD?

A

Poor septum between atria and ventricles,

148
Q

What are signs of AVSD?

A

Murmur of valcular regurgitation rater than septal defects. Thrill gallop rhyhm, active precordium, poor feeding faulure to thrive, tachypnoea

149
Q

What is epidemiology of PDA?

A

Up to 60% 30 weeks prem.

150
Q

What kind of murmur does PDA sound like?

A

Left sternal edge or clavicular area, murmur all the time machinary like

151
Q

How to manage ASD?

A

Rarely cause symptoms but close if found at 3-4 years, for moderate to sever ones

152
Q

What is management of VSD and PDA?

A

moderate to severe, or symptomatics optimise feeds to thrie diuretics and surgical closure of the valve

153
Q

What are signs of AS?

A

Weak femorals thrill ejection systolic murmur loudest in aortic area radiating to carotids.

154
Q

What are symptoms of AS?

A

Reduced exercise tollerance, fatigue poor feeding syncope collapse.

155
Q

What is the 2nd most common stenosis in children?

A

pulmonary stenosis Often radiates to the bacl

156
Q

What is the role of the PDA in coarctation of the aorta?

A

The duct supplies the lower limbs, pre and post ductal saturations are lower than preductal.

157
Q

What are signs of Coarctation of aorta?

A

Weak femorals compared to brachials,

158
Q

What are the common cyantotic conditions?

A

Transposition of the great arteries, tetralogy of fallot?

159
Q

What allows survival in the transposition of the great arteries?

A

Need ASD VSD or PDA to allow mixing of oxygenated blood

160
Q

What are intervention for transposition of great arteries?

A

spetotomy and kep PDA open

161
Q

What is tetralogy of fallot associated with?

A

Di George syndrome

162
Q

What is total anomalus pulmonarty venous return?

A

Very blue sick pink blood form lungs goes to right intead of left

163
Q

What syndromes are associated with congenital heat disease?

A

Trisomy 21, Turner’s syndrome, williams syndrome, Di George syndrome, Noonans syndrome

164
Q

What congential cardiac defects are associated with trisomy 21?

A

AVSD, TOF, VDS

165
Q

What conditions are associated with turner’s syndrome?

A

Coarctation AS bicuspid aortic valve and aortic dissection in later life

166
Q

What is associated with williams sydrome?

A

Supravalcular aortic stenosis, PA stenosis

167
Q

What is assiciated with Di Gearoge syndrome

A

interrupted aortic arch, turncus arteriosis, TOF VSD PDA

168
Q

Noonans syndrome what conditions are related to it

A

PS LVH

169
Q

What is important with neuro historytaking?

A

Neurogenetic or neurometabolic conditions birth history and developmental, is there regresion

170
Q

Why does motor development start head to toe?

A

Pyramidal development.

171
Q

when should primitive reflexed disappear?

A

After 6 months or so

172
Q

What is the use of head circumference?

A

Show microcephally or macrocephally might lead you to a diagnosis

173
Q

what is plagiocephally?

A

asymetrical skulls unilateral premature closure of lamboid and coronal suture

174
Q

What is gowers sign?

A

Hip girdal weakness can be duchenne muscular dustrophy,

175
Q

What is brachycephaly?

A

Premature fusion of coronal suturea flat oxyput not moving

176
Q

What is trigonocephaly?

A

Triangle at from

177
Q

What is scaphocephaly dolicocephaly?

A

From extreme prematurity

178
Q

What is exycephaly?

A

Tower skull

179
Q

What is sturge weber syndrome?

A

Get port wine stain in trigeminal nerve often get epilepsy

180
Q

What are the measure for facial abnormality?

A

Interpupullary distance, inner canthal distance outer canthal, interalar distane, philtral lent upper lip thikness lowerlip thickness, intercommisural distance

181
Q

What is Rett sydrome?

A

Women only get 9 month normal development then decline

182
Q

What is paroxysmal tonic upgase?

A

Initially benign with negative investigation and evential complete resolution, similar picture from oteher conditions

183
Q

What is the worry with opsoclonus myoclonus syndrome?

A

Could have nuroblastoma, different to nystagmus

184
Q

What is Hyperkeplexia?

A

get siezure whentapped on forehead, causes apnea and bradycardia

185
Q

Who can request genetics tests?

A

Anyone if it s relevant to their role

186
Q

When can clinical geneticsreferrals be made?

A

Preconceptual scans, antenatally, Paediatrics, family members after diagnosis, carrier testing adult onset conditions. postmortem,

187
Q

What genetic disrders are ordered?

A

Chromosomal anormalites singly gene disorters dominant recesssive or x linked, genetic and environmental

188
Q

How useful is a microarry?

A

Can pick up 30% of children with developmental delay

189
Q

Whe does tortion testicular happen?

A

After birth, puberty but can happen at any time.

190
Q

What are sumptoms of testicular torsion?

A

Very severe pain, nausea vomiting, late signs are redness and swelling tender testicle

191
Q

What is a tortion of appendix testis?

A

Upper pole of testicle, mimics torsion usually not as severe often in prepubertal boys, can be seen as blue dot, may be acute

192
Q

How can you tell its idiopathic scrotal oedema?

A

swelling and rednress that often is less tender but also extens around the perenium as well as scrotum

193
Q

When is a circumcision indicated in children?

A

Balanitis xerotica obliterans causes sclerosis of the urethra

194
Q

Who deals with hypospadias?

A

urology

195
Q

If there is a hypospadia what do you need to check and why?

A

Check testes if not hterhe could have congenital adrenal hyperplasia

196
Q

Which type of inguinal hernia do children usually get?

A

Indirect through the ring

197
Q

How to distinguesh hernia and hydrocele?

A

hydrocele is more transiluminable, can get above a hydrocele, but cant get above the hernia. to do with the inguinal rings

198
Q

Who get inguinal hernias?

A

More urgent in children, more boys 80%,

199
Q

What are some common head and neck lumps?

A

Lymph nodes

200
Q

What are lymph node swelling red flags?

A

Greater than 2cm, infammed for 2 weeks, enlarging

201
Q

What are the umbilical problems?

A

Reminents of vitelline duct, can attatch to meckles diverticulum, the urachus from the umbilicus

202
Q

What do you do with umbilical heria?

A

Don’t operate unless causing problems

203
Q

What is gastroschisis?

A

Bowel is outside the body with no covering bowel exposes, reduce surgicaly

204
Q

What is exophalos?

A

Bowel in the umbilical cord and bowel covered coexists with congenital abnormalitiess

205
Q

What can cause acute respiratory distress?

A

Oesophageal atresis, congenital diaphragmatic hernia, congenital airway malformations

206
Q

What is assicaiated with diodenal atresia?

A

Trisomy 21 VACTERL

207
Q

What is hirshprungs disease?

A

Failure of normal ganglion cells to complete migration. missing ganglion cells missing progressive distension, need usually wasouts then pull through operation

208
Q

What is meconium ileus?

A

Associated with CF, thick intestinal secretions for m pelets blociing terminal ilium.

209
Q

What is NEC?

A

THe bacteria overgrow in the premature bowel leading to infection and can get perforation

210
Q

What is a strabismus?

A

Misalignment of visual axes,

211
Q

What are types of strabismus??

A

Esotropia Exotropia hypertropia hypotropia, manifest latent or

212
Q

What is latent strabismus?

A

When they are aligned but when covered there is one that splits off exophoria

213
Q

What causes strabismus?

A

Either hereditary or refractive error often uncorrected hypermetropia anisometropia and develipment of amblyopia
loss of vision neurological defects (acute onset and have other signs) anatomical mechanical effects febrile illness

214
Q

What is amblyopia?

A

reduced vision in one eye after correction of any refractive error

215
Q

When is a sqint normal?

A

Before 4 months

216
Q

What to ask in stabismus history?

A

Type when does it happen family history birth history and general health

217
Q

How to detect strabismus?

A

Corneal reflections should be symetrical. Cover test, cover and uncover for manifest and alternat for latent strabismus.

218
Q

What is pseudostrabismus?

A

Epicanthus, narrow or wide interpupillary distance, facial asymetry, unilateral ptosis deep set or prominent eyes

219
Q

What is the problem wiht strabismus?

A

can affect acuity

220
Q

What are treatmetn of amblyopia?

A

Refrative adaptation weraing refractive glasses, occlusion therapy block good eye, atropine drops/ointment in better seeing to dilate the pupil and paralyse accommodation, blurs the vision

221
Q

What is treatment for strabismus?

A

optical recraction or hypermetropia, prisms orthoptic exercises

222
Q

How much weidht is it ok for babies to lose in the first week?

A

10% up to

223
Q

What is definition of faltering or concerning growth?

A

Dropping 1 centile if a small child or dropping more than 3 in a larger child

224
Q

What are good predicters for height?

A

Mid parental height and progress along centile

225
Q

What are the general classification of causes of failure to thrive?

A

Poor intake, malabsorption, excessive expenditure and endocrine or psychosocial

226
Q

What are causes of intake?

A

Breast-feeding poorly, bottle feeds too dilute, Juice driners, cleft palate, exclusion diets, deuromuscular disorder, Vomiting, eating disorders

227
Q

What are symptoms of GORD?

A

Resp/ENT, aspiration pneumonia bronchospam wheeze, apnoeas, cyanotic eposodes cought stridor hoarsness, otitis media glue ear, Oesopjagitis, chest epigrastric pain, irritability, anaemia, haematemesis, dysphagia, peptic stricture causing obstruction

228
Q

What can cause malabsorption?

A

Cows’s milk protein allergy enteropathy liver disease, pancreatic. (CF schwanchmann-diamond syndrome, enzyme deficiency chronic pancreatitis and failure
Diarrhoes

229
Q

What is diarrhoea often a symptom of?

A

Malabsorption of some form

230
Q

How to diagnose cows milk protein allergy?

A

Not got a diagnostic test, trial removing protein

231
Q

What is post-infective diarrhoea?

A

Diarrhoea after infection related mucosal interity which gives an inflammatory diarrhoea.

232
Q

What do you need to make sure when doing TTG test for coealiac?

A

That they don’t have IGA deficiency

233
Q

What are the disacaridase defieciency?

A

Lactose sucrase-isomaltase, fructose

234
Q

What do you do to screeen for IBD?

A

CRP, ESR, FBC, Albumin Fawcal calprotectin,

235
Q

How to approach diarrhoea?

A

If no systemic sympromts do food related diary and modifiying diet if not changes, Total IgA, anteendomysial IgA TTG CRP, ESR, FBC LFT, Possibly faecal elastace faecaes MC&S parasite and virus screen calprotectin
Nutrition approace, Ferritin RBC TIBC folate, vitb12 ADE clotting micronutrients bone profile
With systemic symptoms might want endoscopy sweat test for CF,

236
Q

What are main food allergens?

A

Dairy soy wheat egg nuts and fish

237
Q

What treatments to avoid in children?

A

Anti-diarrhoeals might not help and masque problems

238
Q

What can cause chronic excess energy expendatere?

A

Congenital heart disease, Chronic renal failureCF inflammation tumourse catabolic states

Phase 3a (9 decks)

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