Paeds Flashcards
1
Q
What are the symptoms of pneumonia
A
- Raised Temp.
- Poor feeding
- Tachypnoea/cardia
- Cyanosis
- Sternal/costal recession
- Grunting
- Older children may have typical signs/symptoms
2
Q
How might you manage pneumonia
A
- Amoxicillin (1st line)
- Co-amoxiclav
- Azithro/Erythromycin
3
Q
What are the symptoms of Croup
A
- Stridor
- Barking cough
- Sternal/costal recession
- Hoarse voice
- Raised temp.
- Poor feeding
- Tachypnoea/cardia
4
Q
How might you treat Croup
A
- Steroids (1st line)
- Oxygen
- Nebulised adrenaline if very severe
5
Q
What is important to recognise/rule out with croup
A
- Bacterial tracheitis
- Epiglottitis
6
Q
How might Bacterial tracheitis present and how do you treat it
A
- Hx of viral infection followed by deterioration
- Stridor/barking cough/difficulty breathing
- Thick exudate/tracheal mucus that risks occluding airways as is not cleared by coughing
- IV antibiotics
7
Q
How might Epiglottitis present and how do you treat it
A
- AVOID EXAMINING THROAT
- Difficulty breathing
- Severe pain (worse on swallowing)
- Stridor/braking cough minimal or absent
- Difficulty swallowing/drooling
- Intubation by anaesthetist and IV antibiotics
8
Q
How might Bronchiolitis present
A
- Fever
- Poor feeding
- Tachypnoea/cardia
- Wheeze
- Costal/sternal recession
- Grunting
- Cyanosis/pallor
9
Q
What is the most common cause and treatment of Bronchiolitis
A
- RSV
- Supportive management
- Oxygen
- CPAP
- Upper airway suctioning
10
Q
How might Whooping cough (pertussis) present
A
- Apnoea
- Bouts of coughing (child can go blue/red) ending in vomiting
- Whoops
11
Q
How might you manage whooping cough (pertussis)
A
- Worse in infants so admit for monitoring
- Erythromycin within first 21 days
12
Q
What are the symptoms of Asthma
A
- Bouts of difficulty breathing
- Wheeze
- Cough
- Often worse at night
- Often identifiable trigger
13
Q
What are some of the common precipitating factors for asthma
A
- Cold air
- Exercise
- Allergens (eg. pets)
- Smoke
- Stress
14
Q
How might you investigate suspected asthma
A
- PEFR (diary)
- Spirometry
- Functional exhaled NO
15
Q
How might you manage asthma
A
- SABA (salbutamol)
- SABA + ICS (pred.)
- SABA + ICS + LABA (salmeterol)
16
Q
How might Cystic fibrosis present
A
- Meconium Ileus (failure to pass stool or a vomit in first 2 days of life, bowels seen as distended, can sometimes see meconium ileus mass)
- Lung disease (bronchiectasis like) - coughing, noisy breathing, productive
- Pancreatic insufficiency - Steatorrhea / vomiting/ malnutrition
17
Q
How might you manage cystic fibrosis
A
- Education
- Vaccination/antibiotic prophylaxis
- ICS/SABA for resp. relief
- Panc. enzyme replacement + vitamins
18
Q
How might Otitis media present
A
- Sudden onset earache
- Hearing loss
- Discharge
- Fever
- Poor feeding
- Balance difficulties
19
Q
What might you see under the otoscope in otitis media
A
- Red/yellow/cloudy eardrum - be wary the eardrum can be pink/red in response to fever
- Bulging of tympanic membrane/fluid and loss of landmarks
- Perforation
20
Q
What is the management of otitis media
A
- Paracetamol/ibuprofen for the pain
- Otomize
- Amoxicillin (1st line)
21
Q
What is glue ear
A
- Fluid effusion behind the eardrum/in the middle ear
22
Q
What are the symptoms of glue ear
A
- Hearing loss (most common)
- Earache
- Tinnitus
23
Q
How might you manage glue ear
A
- Watch and wait, most resolve spontaneously
- Auto inflation
- Grommet insertion
24
Q
Describe bicuspid aortic valve
A
- Bi instead of tricuspid valve
- Most common CHD
- Mostly asymptomatic at birth but at increased risk of becoming stenosed in adulthood
- Stenosis is a diastolic murmur heard best in right upper sternal edge
25
Describe atrial septal defects
- Normal shunt is L-R so acyanotic
- Can develop PH overtime leading to RH hypertrophy and Eisenmenger's causing cyanosis
- Ejection systolic murmur
26
Describe ventricular septal defects
- Normal shunt is L-R so acyanotic
- In larger holes Eisenmenger's can occur leading to cyanosis
- Systolic murmur at the lower left sternal border
27
Describe patent arteriosus ductus
- Persistent communication between proximal pulmonary artery and descending aorta
- Increases load on right heart leading to RH hypertrophy/failure
- Continuous murmur
28
Describe tetralogy of fallot
Combination of
- Large VSD
- Overarching Aorta (the valve is lower in the ventricle meaning the ventricle has to work harder to eject)
- RV outflow obstruction
- RV hypertrophy
RV outflow obstruction plus hypertrophy lead to raised RH pressure causing flow from R-L causing cyanosis
Ejection systolic murmur at the left mid and upper sternal border
29
What are the signs/symptoms of infective endocarditis
- Clubbing
- Splinter haemorrhage
- Fever
- Anaemia/pallor
- Heart failure/murmur
- Splenomegaly
- Arthritis/Arthralgia
30
What is scarlet fever
- Group A strep. infection of the throat
31
How might scarlet fever present
- Pale red bumpy pinpoint (sandpaper) rash
- Skin may peel after rash resolves
- Sore throat
- Strawberry tongue
- Fever
- Cervical lymphadenopathy
- Flushed face
- Petechiae inside mouth
32
How can you treat scarlet fever
- Penicillin V
| - Paracetamol/ibuprofen for pain/fever
33
What is rheumatic fever
- A systemic febrile illness caused by sensitivity reaction to group A strep. infection (scarlet fever)
- Can cause permanent heart valve damage
34
How might rheumatic fever present
- 2-4 weeks post scarlet fever/throat infection
- Fever
- Inflamed joints
- Chest pain
- Difficulty breathing
- Tachycardia
35
How can you manage rheumatic fever
- Bed rest until resolved
- Benzylpenicillin followed by penicillin V
- Aspirin
- Steroids in severe carditis
36
What are the symptoms/signs of GORD
- GOR is common on infants <1 yrs old
- Poor feeding
- Vomiting (especially after feeding)
- Faltering growth
- Crying when lying flat
- Hoarseness/cough
- Older children may have typical symptoms/signs
37
What investigations might you do for GORD
- 24 hour pH monitoring
- Barium swallow
- Endoscopy
38
How might you manage GORD
- Ant. acids/Gaviscon
- PPIs/H2 receptor antagonists
- Fundoplication
39
What are the symptoms/signs of pyloric stenosis
- Projectile vomiting
- Constipation
- Faltering growth
- Dehydration
40
What investigations might you do for pyloric stenosis
- Can often feel thickened pylorus after feed
| - USS
41
How do you manage pyloric stenosis
- Surgery
42
What are the signs/symptoms of IBD
- Diarrhoea
- Blood/mucus in stool
- Constipation
- Abdominal pain
- Mouth ulcers
- Weight loss
- Fatigue
43
What investigations might you do for IBD
- FBC/inflamm. markers
- Faecal calprotectin
- H. pylori stool test
- Colonoscopy and biopsy
44
How can you manage IBD
- Steroids
- Azathioprine
- Infliximab
- Surgery
45
What are the symptoms/signs of Appendicitis
- Severe sudden onset pain (umbilicus, migrates to RIF)
- Nausea and vomiting
- Fever
- Guarding
- Rebound tenderness
46
What investigations might you do for appendicitis
- USS (preferred)
| - CT/MRI
47
How might you treat appendicitis
- IV antibiotics
| - Surgery
48
What are the signs/symptoms of coeliac disease
- Steatorrhoea
- Constipation
- Reflux/Vomiting
- Weight loss/malnutrition
- Bloating/abdominal pain
- Faltering growth
49
What investigations might you do for coeliac disease
- IgA tTGA and total serum IgA
| - Endoscopic intestinal biopsy (diagnostic)
50
How might you manage coeliac disease
- Gluten free diet
51
What are the symptoms/signs of intussusception
- Severe abdominal pain (initially episodic but becomes more constant in nature)
- Vomiting
- Constipation (can also be diarrhoea)
- Poor feeding
- Redcurrant jelly stools (blood stained mucus)
- Fever
52
What investigations might you do for intussusception
- Can sometimes feel in abdomen
| - USS
53
How might you treat intussusception
- Barium or air enema
| - Surgery
54
What is Hirschsprung's disease
- Congenital abnormality causing absence of nerve ganglions in a segment of bowel, causing loss of intestinal movement leading to constipation and obstruction
55
What are the signs/symptoms of Hirschsprung's disease
- Failure to pass meconium
- Bloating
- Bilious vomit
- Constipation
- Poor feeding/weight gain
- Hirschsprung's related enterocolitis (watery foul diarrhoea, fever, vomiting)
56
What investigations might you do for Hirschsprung's disease
- Rectal exam
| - Rectal biopsy (absence of nerve ganglions)
57
How do you manage Hirschsprung's disease
- Surgery (pull through)
| - May need a stoma
58
How might a UTI present
- Often very generalised symptoms
- Poor feeding
- Fatigue/distress
- Fever
- Vomiting
- Abdo. pain
- Offensive urine
- Dip all fevers without established cause and if no improvement with treatment
- Older children may have more typical presentation
59
How do you investigate a UTI
- Urine dipstick
- Urine culture
Methods of collecting include
- Clean catch
- Catheterisation
- Suprapubic aspiration
60
How do you treat UTI
- <3 months iv amoxicillin and gentamycin or iv cephalosporin
- >3 months Trimethoprim or nitrofurantoin
- Pyelonephritis gentamycin
61
What is nephrotic syndrome
Triad of
- Proteinuria
- Hypoalbuminemia
- Generalised oedema
- Often accompanied by hypercholesterolaemia
In children usually caused by minimal change disease
62
How might nephrotic syndrome present
- Frothy urine
- Generalised oedema
- Fatigue
- Ascites
63
What investigations might you do for nephrotic syndrome
- Urine dipstick
- Albumin to Cr ratio
- Biopsy (rare)
64
How can you treat nephrotic syndrome
- Steroids
- Diuretics for symptom relief
- Biologic agents
65
How might glomerulonephritis present
- Coca cola urine (haematuria)
- Oedema
- Oliguria
- Fatigue/malaise/pruitus (Raised urea in bloodstream)
66
What are the two important causes of glomerulonephritis
- Post strep. infection
| - Henoch Scholein Purpura
67
Describe post Strep. nephritis
- Preceding (usually) throat infection with group A strep. (scarlet fever)
- Treat with penicillin
68
Describe Henoch Scholein Purpura
A vasculitis caused by IgA attacking the blood vessels post infection (usually)
Causes
- Arthritis + periarticular oedema
- Rash of raised red or purple spots
- GI problems (vomiting, bloody stools)
- Nephritis
If kidney involvement treat with steroids in hospital
69
Describe a macular rash
- A flat skin discolouration
70
Describe a papular rash
- Small raised spots less than 0.5cm in diameter
71
Describe a maculopapular rash
- A rash consisting of flat discolouration and raised spots
72
How might erythema toxicum neonatorum present and how do you treat it
- Onset usually first few days - a week after birth
- Erythematous macules and white papules
- May also be pustules (puss filled lesion)
- Should be otherwise well
- Does not require treatment
73
How might chickenpox present and how do you treat it
- Itchy red spots
- Initially spots are filled with fluid, but then scab over
- Fever
- Aches pain and malaise
- Loss of appetite
- Fluids and paracetamol
- BE WARY that if fever initially settles then recurs then this can be due to secondary bacterial infection
74
How might measles present and how do you treat it
- Red maculopapular rash widespread
- Grey/white spots on inside of cheek (kopliks spots)
- Conjunctivitis (photosensitive)
- Fever
- Cold like symptoms (runny nose, cough sneezing etc.)
- Check their vaccination Hx
- Fluids + paracetamol/ibuprofen
75
How might Rubella present and how do you treat it
- Pink/light red maculopapular rash, starts in face then spreads
- Lymphadenopathy
- Fever
- Generalised symptoms
- Check vaccination Hx
- Can only be diagnosed in a lab
- Fluids + paracetamol/ibuprofen
76
How might slapped cheek (fifth disease) present and how do you treat it
- Bright red macular rash on both cheeks
- A few days later develop a maculopapular rash on chest, arms and legs
- Fever
- Cold-like symptoms
- Fluids + paracetamol/ibuprofen
77
How might hand foot and mouth disease present and how do you treat it
- Mouth ulcers
- Maculopapular rash on hands and feet which develops into blisters
- Fever
- Prodrome of malaise, loss of appetite and cough
- Fluids + paracetamol/ibuprofen
78
How might mumps present and how do you treat it
- Swollen parotid gland (usually one swells for a few days then the other follows)
- Difficulty swallowing/earache due to swelling
- Fever
- Malaise/muscle ache
- Loss of appetite
- Check vaccination Hx
- Diagnosis confirmed via. oral swab
- Fluids + paracetamol/ibuprofen and warn about complications (epididymo-orchitis/meningitis)
79
How might Herpes simplex labialis present and how do you treat it
- Mouth ulcers typically on lips
- Fever
- Malaise/ sore throat
- Lymphadenopathy
- Fluids + paracetamol/ibuprofen
- Anti-virals (acyclovir)
80
How might impetigo present and how do you treat it
- Pustules - red and golden crust, fading to erythema
- Commonly on face, limbs and flexures
- Hygiene advice and hydrogen peroxide cream on topical antibiotics
81
How might scalded skin syndrome present and how do you treat it
- Red blistering skin (looks like a burn)
- Fever
- Dehydration
- Hospitalisation for iv flucloxacillin
82
How might meningitis/meningococcal septicaemia present and how do you treat it
- Fever
- Nausea and vomiting
- Headache and neck stiffness
- Non-blanching petechial purpuric rash
- IV antibiotics (do not delay/wait for cultures)
83
How might Kawasaki disease present and how do you treat it
- A form of acute vasculitis
- Rash which may be maculopapular or target like (redness with white spot in middle)
- Red cracked lips and strawberry tongue
- Redness of eyes (conjunctivitis) without exudate
- Lymphadenopathy
- Firm swelling of hands and feet (oedema)
- Diagnosis mostly of exclusion (eg. scarlet fever presents very similarly)
- Treated with iv immunoglobulin
84
How might toxic shock syndrome present and how is it treated
- Is when bacteria enter bloodstream (often associated with a wound/burn or tampons)
- Red/pink sunburn like rash (peels)
- Lips tongue and white of eyes turn red (conjunctivitis)
- Malaise/ache
- Fever
- Confusion/fainting/light headed and dizzy
- Difficulty breathing
85
How might scabies present and how is it treated
- Generalised pruritis (worse at night)
- Maculopapular red rash (often between fingers, flexors, umbilicus, buttocks and inside of thighs)
- May see white/grey wavy lines on skin (burrows)
- Ask about close contacts/house itching- often associated with overcrowding
- Treat contact and patient with topical insecticide (permethrin 5% 1st line)
86
How might eczema present and how is it treated
- Itchy, dry, flaky, erythematous rash
- In children often affects flexures, behind ears or cradle cap
- May be atopic/associated with a trigger
- Emollients - recognise and avoid triggers and steroid cream (hydrocortisone 1% is first line)
- If infected (Weepy, crusted pustules may have fever) swab and treat with flucloxacillin
87
How might urticaria present and how do you treat it
- Red raised rash, blotchy and irregular sized
- itching/burning
- Atopy associated
- Anti-histamines or steroids if severe
88
What are the main causes of anaemia in children
- Iron deficiency (dietary, malabsorption - coeliac)
- Haemolysis (malaria - ask travel Hx, sickle cell)
- Blood loss
- Chronic disease
89
Why do children get iron deficiency anaemia and how might they present
- They have an increased need for iron and they have poor absorption/ dietary intake
- Pallor
- Irritability
- Tachycardia
- If severe then heart murmur, splenomegaly and anorexia
90
How can you investigate and manage iron deficiency anaemia
- FBC/ blood film- microcytic, hypochromic, Low ferritin/serum iron
- Oral iron tablets
91
How might a child with sickle cell anaemia present
- Painful dactylitis (Swollen bones of hands/feet)
- Severe infections
- Acute painful crisis
- Acute chest syndrome
- Splenomegaly
- May have delayed development/cognitive difficulties
92
How might you investigate/manage sickle cell anaemia
- FBC/blood film
- Manage acute crisis/complications
- Stem cell transplant
93
Describe haemophilia A and B
- Lack of clotting factors XIII (A) and IX (B)
- Presents with prolonged bleeding and bleeding into joints and muscles
- Treat with clotting factors XIII and IX
94
Describe ITP
- low levels of thrombocytes
- Has acute and chronic forms, acute form often follows a viral illness
- Symptoms include petechiae, prolonged bleeding and bruising
95
What are the two main leukaemia's that affect children
- Acute lymphoblastic leukaemia (ALL) 85%
| - Acute myeloid leukaemia (AML) 13%
96
How might a brain tumour present and what are the most common types
```
Signs of raised ICP
- Headache
- Vomiting
- Seizures
- Irritability
- Drowsiness
Astrocytoma (40%)
Medulloblastoma (20%)
```
97
What investigations might you do for a brain tumour
- CT head
- MRI
- Bloods
- Biopsy
98
How might a Wilms tumour (nephroblastoma) present
- Painless abdominal swelling (most common)
- Pain
- Haematuria
- Fever/ weight loss
99
How might you investigate a Wilms tumour
- USS abdomen
- CT
- MRI
- Bloods
- Biopsy
100
How might a neuroblastoma present
Sites commonly affected are
- Abdomen - Painful swollen abdomen/constipation
- Chest - Breathlessness/difficulty swallowing
- Neck - Lump in neck
- Pelvis/spine - Leg weakness/numbness/difficulty passing urine/back pain
- Fever/weight loss
101
What are the causes of respiratory problems in a neonate
Little or no surfactant
- Retained in the type 2 pneumocytes
Little or no alveoli
- None at 24 weeks then amount rises exponentially
102
How can you treat respiratory distress in a neonate
- Give steroids before birth in premature babies, switches on type 2 pneumocytes to release surfactant
- Surfactant
- Oxygen
- Ventilation
103
What are the complications of respiratory distress in a neonate
```
Death
Chronic lung disease of prematurity
- Caused by oxygen toxicity and high pressure on ventilators, which causes fibrosis/scarring of lung
- Decreased lung volume
- Decreased alveolar SA
- Decreased diffusion
```
104
Describe apnoea of prematurity
- Brain stem not fully myelinated until 32-34 weeks
- This can cause the baby to 'forget' to breathe
- Can often be made worse by sepsis
105
How can you treat apnoea of prematurity
- Phosphodiesterase inhibitors (caffeine)
| - NCPAP
106
What is cystic periventricular leukomalacia
- Cysts around the ventricles causing neurological deficit (spasticity)
- The closer to the ventricle the more likely the contralateral leg is affected, the further the more likely the arm
- Can also affect other modalities
107
Describe jaundice of the newborn
Any jaundice >2 weeks in term or 3 weeks in preterm need investigating!!!!!!!
- Unconjugated - worrying - Fat soluble bilirubin can dissolve into fat of brain causing kernicterus (damage to basal ganglia of brain casing cerebral palsy)
- Caused by haemolysis, prematurity, metabolic disease sepsis and dehydration
- Conjugated high levels are not worrying other than finding cause
108
How might necrotising enterocolitis present
- Swollen tender abdomen
- Problems feeding/ vomiting
- Blood in stools
- Generally unwell
- More common in premature
- Can lead to perforation- peritonitis/sepsis
109
How might you treat necrotising enterocolitis
```
Medical
- Bowel decompression
- Bowel rest
- Broad spectrum antibiotics
Surgical
- Drain
- Bowel resection
```
110
How might Juvenile idiopathic arthritis (JIA) present
- Persistent swelling
- Pain
- Joint stiffness (especially morning)
- Warmth/redness
- Joint deformity
- Loss of range of motion
111
What are the sub types of JIA
- Oligoarticular (4 or less joints - usually knee/ankle)
- Polyarticular (5 or more joints - usually small joints of hands/feet)
- Psoriatic arthritis (dactylitis, Nail pitting, family Hx psoriasis)
- Enthesitis related (often involvement of SI joints)
112
How can you manage JIA
- Steroids
- Methotrexate
- TNF alpha inhibitors (infliximab)
- Biologic agents
113
What is rickets
- Low vitamin D or calcium levels leading to low serum calcium causing reabsorption of calcium form the bones, leading to soft and weak bones, with poor growth
114
How might rickets present
- Bone pain
- Visible bone deformity
- Dental problems
- Poor/stunted growth
- Fractures
115
What investigations might you do for rickets
- X-ray
| - Bloods - Bone profile
116
How can you manage rickets
- Dietary advice
| - Supplementation/injection
117
How might osteomyelitis present
- Fever
- Bone pain
- Bone swelling
- Warmth/redness
118
How might you treat osteomyelitis
- IV antibiotics
| - Surgery
119
How might septic arthritis present
- Sudden onset severe joint pain
- Joint swelling
- Redness/warmth
- Fever
120
How do you manage septic arthritis
- IV antibiotics
| - Surgery/drainage
121
How might reactive arthritis present
- Joint pain
- Swelling of joint
- Redness/warmth
- Post infection
122
How do you manage reactive arthritis
- Treat/manage underlying cause if necessary
| - Steroids/DMARDs
123
Describe scoliosis
- Curvature of the spine
- May appear to be leaning to one side/uneven shoulders
- Usually given back brace until they stop growing- then surgery
124
What are the 4 domains of child development
- Gross motor
- Fine motor and vision
- Speech/language and hearing
- Social interaction and self care
125
How would a child normally develop their gross motor skills up to a year old
```
Newborn
- Flexes both arms and legs
- Equal movements
3 Months
- Lifts head on tummy
6 months
- Rolls over
- Sit unsupported
9 months
- Crawling
- Pulls to stand
1 year
- Cruising furniture
- Walking
```
126
How would a child normally develop their gross motor skills from 1 to 5 years old
```
1 year
- Walking
2 years
- Walks up steps
3 years
- Jumping
4 years
- Hopping
5 years
- Rides bike
```
127
How would a child normally develop their fine motor and vision
skills up to a year old
```
4 months
- Grasps objects
8 months
- Holds a cube
- Transfers hand to hand
1 year
- Good pincer grip
- Scribbles with a crayon
```
128
How would a child normally develop their fine motor and vision skills from 1 year to 3 years
```
1 year
- Scribbles with crayon
18 months
- Tower of 2 cubes
3 years
- Tower of 8 cubes
```
129
How would a child normally develop their speech, language and hearing skills up to a year old
```
3 months
- Squeal and laugh
6 months
- Double syllable babble
9 months
- Dada and mama
12 month
- 1 word
```
130
How would a child normally develop their speech, language and hearing skills from 1 year to 5 years
```
1 year
- 1 word
2 years
- 2 word sentence
- Name body parts
3 years
- Mostly understandable speech
4 years
- Colours
- Count 5 objects
5 years
- Meaning of words
```
131
How would a child normally develop their social and self care skills up to a year old
```
6 weeks
- Smiles spontaneously
6 months
- Finger feed
9 months
- Waves bye bye
12 months
- Uses a spoon/fork
```
132
How would a child normally develop their social and self care skills from 1-5 years
```
1 year
- Uses a spoon/fork
2 years
- Takes some clothes off
- Feed a doll
3 years
- Plays with others
- Names a friend
4 years
- Dress with no help
- Play board games
```
133
When do you worry about missing milestones in child development
```
If there is any regression of development
Gross motor
- Not sitting by 1 year
- Not walking by 18 months
Fine motor
- Hand preference before 18 months
Speech and language
- No words by 18 months
Social
- Not smiling by 3 months
- No response to carers by 8 weeks
- Not playing with others by 3 years
```
134
What causes hypoxic ischaemic encephalopathy
Occurs secondary to a significant hypoxic event occurring immediately before or during labour/delivery
135
How can hypoxic ischaemic encephalopathy present
```
Mild
- Irritable
- Poor feeding
- Hyperventilation
Moderate
- Tone/movement abnormalities
- Cannot feed
- Seizures
Severe
- No normal spontaneous movements or response to pain
- Prolonged seizures
- Multi-organ failure
```
136
How can you manage hypoxic ischaemic encephalopathy
- Respiratory support
- Anti-convulsants
- Mild hypothermia may protect brain
- Fluid and electrolyte balance
137
What can cause small bowel obstruction in a neonate
- Meconium ileus (associated with cystic fibrosis/plug)
| - Atresia/stenosis
138
How might small bowel obstruction in a neonate present
- Persistent often bilious vomiting
| - Abdominal distention
139
Describe peri-orbital cellulitis
- Erythema/oedema of the eyelid
- Fever
- Requires iv antibiotics to stop orbital cellulitis developing
140
Describe orbital cellulitis
- Erythema/oedema of eyelid
- Ptosis
- Painful/limited ocular movement
- Decreased visual acuity
- Can lead to abscess formation/meningitis
141
How might type 1 diabetes present
- Peaks in pre-school and in teenagers
- Polyuria and polydipsia
- Weight loss
- DKA
142
How can you diagnose type 1 diabetes
- Random blood glucose >11mmol/L
- Fasting blood glucose >7mmol/L
- Keton/glycosuria
- Raised HbA1c
143
How does diabetic ketoacidosis occur
- Decreased insulin leads to decreased glucose uptake by cells causing ketone formation
- Also there is fluid loss due to marked glycosuria
- This increases conc. of ketones in blood, leading to acidosis
- Respiratory and renal compensation cause hyperventilation and renal impairment due to dehydration
144
How might DKA present
- Hyperventilation
- Tachycardia
- Vomiting
- Abdo pain
- Pear drop scent
- Dehydration - decreased GCS/confusion
145
How do you manage DKA
- Fluid resuscitation
- Insulin, followed by glucose (avoid hypo)
- Fluid/electrolyte balancing
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How might anaphylaxis present
- Tachypnoea, stridor, wheeze, hoarse voice
- Cyanosis/low oxygen sats
- Pale, clammy, tachycardic+hypotensive
- Oral and facial swelling
- Hives/urticaria rash
- Bloody diarrhoea
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How do you manage anaphylaxis
- Norepinephrine
- Establish airway
- Oxygen+ IV fluids
- Hydrocortisone
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How do you manage status epilepticus
- Check blood glucose
- Rectal diazepam or buccal midazolam
- IV access then administer iv lorazepam
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What is downs syndrome
- Trisomy 21
- Small head, short neck, short stature, flat face, single palmar crease
- Hypothyroid
- Cardiac - ASD/VSD/TOF/PDA
- Learning difficulties
- Leukaemia
- Dementia
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How do you test for down syndrome
- Screened for in all women at 11-14 weeks (nuchal translucency)
- If positive screen then combined test - High bHCG and low plasma protein A
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What is turners syndrome
- 45XO
- Short, webbed neck, Downward sloping eyes, broad chest
- Underdeveloped ovaries/infertility
- Late puberty
- Hypothyroid
- Obesity/Diabetes
- Learning disability
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What is fragile X
- FMRI gene mutation on X chromosome
- Long narrow face, Large ears, large testes, joint hypermobility, hypotonia
- ADHD
- Autism
- Seizure
- MV prolapse
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What is prader willi
- Loss of Y genes on chromosome 15
- Obesity, soft easy bruising skin, narrow forehead, almond eyes, downturned mouth
- Constant hunger, learning difficulties
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What is Williams syndrome
- Deletion of one copy of chromosome 7
- Broad forehead, flattened nasal bridge, wide mouth, small chin
- Very sociable/trusting
- Supravalvular AS
- ADHD
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What is Edwards syndrome
- Trisomy 18
- Low birth weight, small features/head, malformed ears, prominent occiput, cleft lip
- Cardiac defects
- Loads of gastro tract problems
- Horseshoe kidney
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Duchenne's muscular dystrophy
- Dystrophin gene mutation on Xp21
- Calf pseudohypertrophy
- Waddling gait
- Gross motor/global developmental delay
