Paeds Flashcards
outpouching of ileum due to peristence of vitelline duct is known as:
meckel’s diverticulum
absence of ganglionic cells in submucosa is known as :
hirschsprungs disease
infants
- fail to pass meconium
- abdo distention
- vomiting
6 features of cystic fibrosis:
MRS SEW
M- meconium ileus
R- recurrent pneumonia
S- steatorrhoea
S- short stature
E- extra energy needed
W- weight gain poor
which manoeuvre is contraindicated in patients with suspicion of cervical spine injury?
head tilt and chin lift
telescoping of one bowel segment into distal segment:
intussusception
- red current jelly stools
palpable ‘olive’ mass in epigastric region.
non bilious projectile vomiting at 2-6 weeks of life
congenital hypertrophic pyloric stenosis
ileus caused by
aperistaltic bowel
what sign is seen on x-ray in a child with duodenal atresia
double bubble sign
association with downs.
4 y/o ran into a door.
crying. vomited three times.
OE: swelling on forehead, CNS and PNS examination normal.
next best course of action?
options:
a) CT within 1 hr
b) CT within 8 hrs
c) observe 4 hrs
d) discharge now
e) social service involvement
observe for atleast 4 hrs.
CT within one hour if more than one of the following features
- loss of consciousness > 5mins
- abnormal drowsiness
- 3 episodes vomitting
- high impact injury
- amnesia
the child in this case only has one feature!
supplementation with what prior to conception can help prevent neural tube defects
folate
- necessary in nucleic acid synthesis
- 400 micograms a day
however if +FH
- 5mg folic acid
which vitamin prevents keratinised squamous metaplasia
vitamin A supplementation
which vitamin is necessary for pyruvate dehydrogenase function:
thiamine
thiamine deficiency can cause beriberi and wernickes-korsakoffs syndrome observed in alcoholics
11 month old
pc: failure to thrive, weight loss. recurrent diarrhoea, recurrent fevers, breathing difficulties
oe: generalised lymphadenopathy + eczema
likely diagnosis:
HIV
mothers with low viral load can have vaginal delivery, otherwise pre labour C-section done to reduce vertical transmission risk
neonate with
- low birthweight
- jaundice
- small head
- seizures
- acutely unwell
could be due to:
congenital cytomegalovirus
2 day old neonate
pc:
- refusing to feed
- irritable
oe
- hypotonic
- non blanching petechial rash over lower limbs
diagnosis:
early onset neonatal sepsis.
common organism: GBS
treatment of GBS neonatal sepsis
IV benzylpenicillin
gentamicin
10 day old neonate:
pc: blistering rash on scalp and face
oe: jaundice, hepatomegaly, vesicular rash
indicative of:
herpes simplex virus
tx herpes simplex virus
IV aciclovir
conjunctivitis (bilateral purulent discharge from eye) + respiratory distress
likely due to:
chlamydia infection
- can cause pneumonia and conjuctivitis
treatment of chlamydia trachomatis ?
erythromycin
6 week old
pc:
- struggling to feed
- increased work of breathing
- not gained weight in 2 weeks
oe:
- parasternal heave
- loud systolic murmur at left sternal border
indicative of :
ventral septal defect
spontaneous closure common < 1 years.
after 2 years VSD unlikely to close.
what is a common method of diagnosing VSD?
Echocardiography
when is surgical repair indicated in child with VSD?
- poor growth
- uncontrolled heart failure
most appropriate investigation for child with suspicion of meningitis
lumbar puncture
csf fluid for gram staining and microscopy
2 month old
pc: fever + grunting, tacypnoeic, cough, nasal flaring
investigation:
signs of respiratory distress
+ fever –> pneumonia
Ix = CXR
child under 5 with signs of gastroenteritis.
investigation:
only <5% due to bacterial cause.
so need to do electron microscopy of stool
- demonstrates viruses
6 month old
4 day hx paroxysmal cough + fine purpuric eruptions around eyes and neck.
missed her diptheria, tetanus and pertussis vaccinations.
indicative of:
patient have pertussis –> forceful coughing
can lead to traumatic petechiae.
traumatic petechiae
- in periorbital areas
- subconjunctival haemorrhage
which commonly presents with
- palpable purpuric rash
- abdominal pain
- arthralgia
- glomerulonephritis
Henoch-schonlein purpura
- immune complex small vessel vasculitis
glomerulonephritis –> nephritic syndrome –> swelling of ankles and feet
Henoch-schonlein purpura results from:
- IgA deposition
- post URTI or other infection
bacterial cause sof meningitis
NHS
N- neisseria menpngitidis (child and adult; meningococcus)
H- haemophillus influenza
S- strep pneumoniae (adults and elderly)
acute lymphoblastic leukaemia presents with
- progressive anaemia (lethargy + pallor)
- neutropenia (recurrent infections)
- thrombocytopenia (spontaneous bruising, purpura, mucosal bleeding)
may be lymphadenopathy, hepatosplenomegaly –> organ infiltration
what presents with :
- abrupt onset platelet type bleeding
- spontaneous bruising
- petechiae
- mucosal bleeding
idiopathic thrombocytopenic purpura
management of idiopathic thrombocytopenic purpura is:
corticosteroids OR intravenous immunoglobulin
where is a patent ductus arteriosus best heard?
left upper chest , pulmonary area
what is the tetralogy of fallot?
SHOP
S- ventricular septal defect
H- hypertrophy of RV
O- overriding aorta
P- pulmonary stenosis
causes of aortic stenosis:
REC
R- rheumatic heart disease
E- elderly calcification of tricuspid
C- congenital calcification of bicuspid aortic valve
newborn:
cyanotic at birth
CXR : boot shaped heart, holosystolic murmur audible at left lower sternal border
indicative of:
tetralogy of fallot
3 y/o boy
pc:
- cough (dry/ nocturnal/ worse with exercise)
- wheeze
- sob
pmh
- mild excema
indicative ofL
asthma
- intermittent attacks of wheese
pmh of hay fever or eczema is also suggestive of asthma
7 month old
- chronic resp symptoms
- offensive diarrhoea
- failure to thrive
indicative of:
cystic fibrosis
steatorrhoea - malabsorption from pancreatic insufficiency
15 y/o
pc
- intermittent abdo pain + diarrhoea for 2 years
- blood + mucus in stools
- weight loss, periodic fevers
oe
- erythema nodosum on shins
ulcerative colitis
extraintestinal manifestations of IBD involve
- monoarticular arthritis
- erythema nodosum
posititive anti-TTG and anti- EMA antibodies are characteristic of:
coeliacs disease
association with HLA-DQ2, HLA-DQ8
neonate
- forceps delivery
oe
- reduced tone in left arm
- reduced moro reflex (splaying arms and legs in front of their body)
- arm in waiter tip position
classical signs of:
erbs palsy
management: physio
14 y/o, started to limp, in pain, overweight
diagnosis:
slipped femoral epiphysis
secondary school
deficiency in G6PD leads to:
G6PD enzyme needed in RBCs.
Cells become more vulnerable to damage from reactive oxygen species (ROS)
–> leads to haemolysis
G6PD deficiency often presents with:
neonatal jaundice!
- anaemia
- gall stones
- splenomegaly
more common in mediterranean, middle eastern and african parents
X-linked
15 y/o
pc:
- recurrent abdo pain
- bloody diarrhoea
oe
- small for her age
- delayed puberty
- oral and perianal ulcers
indicative of:
Crohn’s disease
notes
- transmural
- skip lesions
perianal fistulae and oral apthous ulcers are not classically seen in UC.
3 key signs of intussusception
SSS
S- screaming, pallor
S-stool, red current jelly
S-sausage shaped palpable abdo mass in RHS abdomen
inheritance of haemophilia A
X-linked recessive
haemophilia A characterised by deficiency in what
factor VII
haemophilia B characterised by deficiency in what
clotting factor IX
5 month old
pc: respiratory distress
hpc: coryzal symptoms 5 day hx
oe: 37.8 temp
- nasal flaring
- intercostal recession
- cyanosis
widespread wheeze and crackles through lung fields
indicative of:
acute bronchiolitis
what syndrome is characterised by deafness and renal failure?
alport syndrome
child has difficulty in hearing, several fractures after minor falls, sclera appear blue, legs short and deformed
indicative of:
osteogenesis imperfecta
18 month old
pc: 4 day hx high fever + coryza
oe: pink blanching maculopapular rash, now spread to arms , fever now settled
indicative of:
Roseola infantum
