Paeds Flashcards
1
Q
O/E Ventricular septal defect
A
Pansystolic murmur in lower left sternal border
2
Q
O/E coarctation of the aorta
A
Crescendo-decrescendo murmur in the upper left sternal border
3
Q
O/E patent ductus arteriosus
A
Diastolic machinery murmur in the upper left sternal border
4
Q
O/E pulmonary stenosis
A
Ejection systolic murmur in the upper left sternal border
5
Q
O/E atrial septal defects
A
Ejection systolic murmur in the pulmonary area and fixed splitting to the second heart sound
6
Q
Which childhood syndrome is associated with microcephalic, small eyes, cleft lip/palate, polydactyly, and scalp lesions?
A
Patau syndrome (trisomy 13)
7
Q
Which childhood syndrome is associated with micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers?
A
Edward’s syndrome (trisomy 18)
8
Q
Which childhood syndrome is associated with learning difficulties, macrocephaly, long face, large ears, and macro-orchidism?
A
Fragile X
9
Q
Which childhood syndrome is associated with webbed neck, pectus excavatum, short stature, and pulmonary stenosis?
A
Noonan syndrome
10
Q
Which childhood syndrome is associated with micrognathia, posterior displacement of the tongue, and cleft palate?
A
Pierre-Robin syndrome
11
Q
Which childhood syndrome is associated with hypotonia, hypogonadism, and obesity?
A
Prader-Willi syndrome
12
Q
Which childhood syndrome is associated with short stature, learning difficulties, friendly personality, transient neonatal hypercalcaemia, and supravalvular aortic stenosis?
A
William’s syndrome
13
Q
Which childhood syndrome is associated with a distinct cry, feeding difficulties and poor weight gain, learning difficulties, microcephaly and micrognathism, and hypertelorism?
A
Cri du chat syndrome (chromosome 5p deletion syndrome)
14
Q
Which childhood syndrome is associated with the following heart defect?
a) Supravalvular aortic stenosis
b) Bicuspid aortic valve
c) Pulmonary stenosis
d) Atrioventricular septal defect
A
a) William’s
b) Turner’s
c) Noonan
d) Down’s
15
Q
Developmental milestone red flags at any age
A
Maternal concern
Discrepancy
Regression
16
Q
Developmental milestone red flags at birth
A
Asymmetric moro
Absent red reflex
Failed neonatal hearing test
17
Q
Developmental milestone red flags by 10 weeks
A
No head control
No smiles
18
Q
Developmental milestone red flags by 6 months
A
Primitive reflex
Hand preference
Squint
Minimal response to people, toys or noise
19
Q
Developmental milestone red flags by 12 months
A
No sitting
Double babble
Pincer grasp
20
Q
Developmental milestone red flags by 18 months
A
Not walking
< 5 words
Mouthing
Drooling
21
Q
Developmental milestone red flags by 36 months
A
No 2 word phrases
Not interactive
22
Q
HEADSSS assessment
A
Home Environment Education Activities Drugs and alcohol Sexuality/Sex Self-harm/suicide Safety
23
Q
What are common innocent murmurs?
A
Systolic ejection murmur
Venous hums
Vibratory murmur
24
Q
Compare characteristics of innocent and pathological murmurs
A
Innocent
- systolic
- musical quality
- no radiation
- varies in intensity w posture and respiration
- asx
- normal peripheral pulses
Pathological
- pansystolic or diastolic
- harsh/long
- thrill, radiation or cardiac sx always indicate pathological
25
What clinical features would you expect in a ventricular septal defect?
Loud hard pansystolic murmur at sternal border, radiating all over chest
Severe: heart failure, breathlessness on feeding and crying, failure to thrive, recurrent chest infections
26
What clinical features would you expect in an atrial septal defect?
Soft systolic murmur in second left intercostal space, wide fixed splitting of the second sound
High flow through pulmonary valve causes systolic murmur
Breathlessness, tiredness on exertion, recurrent chest infections
27
What clinical features would you expect in aortic stenosis?
Systolic ejection murmur at right upper sternal border, radiating to neck and down left sternal border
Exercise-induced dizziness
Loss of consciousness in minority of older children
28
What clinical features would you expect in coarctation of the aorta?
Systolic murmur over the left side of the chest, especially at the back
Absent/delayed weak femoral pulses
Hypertension in arms
29
What clinical features would you expect in pulmonary stenosis?
Systolic ejection murmur over the upper part of left chest anteriorly and conducted ot the back, usually preceded by an ejection click
Associated w cyanosis if > mild
30
What clinical features would you expect with patent ductus arteriosus?
Pansystolic murmur in neonates
Continuous murmur after 3 months of age
Collapsing pulse
31
Three ddx of syncope with normal EEG findings
Syncopal attacks
- blurred vision, lightheaded, sweating, nausea
- helps to lie down
- prolonged standing, painful/emotional stimulus precipitates it
Hyperventilation
- excessive deep breathing
- breath into paper bag to resolve
- excitement precipitates it
Hysterical seizures
- gradual onset, asynchronous flailing movements
- no incontinence or postictal state
- often triggered by emotional stimulus
32
Compare the impact on the heart of the following cardiac problems:
a) atrial septal defect
b) ventricular septal defect
c) aortic stenosis
d) coarctation of the aorta
e) pulmonary stenosis
f) transposition of the great vessels
g) fallot's tetralogy
a) high flow through the pulmonary valve causes systolic murmur
b) blood flows through defect to right side of heart leading to pulmonary HTN, cardiomegaly, and prominent pulmonary arteries
c) stenosis causes enlargement of the left ventricle and prominence of the ascending aorta
d) blood flow to the lower limbs is maintained through a patent ductus arteriosus
e) right ventricle hypertrophies to overcome obstruction presented by stenosis of pulmonary valve
f) pulmonary artery arises from left ventricle and aorta from the left, open ductus allows mixing of the blood
g) pulmonary stenosis, ventricular septal defect w shunt, overriding aorta, right ventricular hypertrophy
33
In which congenital lesion must strenuous activity be avoided?
Aortic stenosis
High risk of sudden death
34
Emergency treatment of severely cyanosed child w poor systemic circulation
IV prostaglandin
- maintain ductus open
Balloon septostomy
- improve mixing of blood within the heart
35
Four characteristics of Fallot's tetralogy
1. Ventricular septal defect
2. Overriding of the aorta
3. Infundibular pulmonary stenosis
4. Right ventricular hypertrophy
36
Which pts are at risk of infective endocarditis?
Congenital heart disease
Indwelling central venous catheter
37
4 yr old with background of atrial septal defect presents with 1/52 fever and 1/7 petechiae and splinter haemorrhages
O/E changing murmur, hepatosplenomegaly
What is causing this and how should it be treated?
Infective endocarditis
- strep, staph main organisms
IV abx given over 4-8 weeks
38
How should a 14 year old girl presenting w syncope be managed?
History
- before/during/after syncope
- any unpleasant stimulus/prolonged standing
Cardiac examination
- including standing + lying BP
Any doubt about fall
- further ECG
Reassure very common in teenage girls due to:
- emotional/painful stimulus
- poor vasomotor reflexes
39
What investigations could you order for diagnosing and leg pain and what could they indicate?
FBC, WCC
- leukaemia
- infections
- collagen vascular disease
Plasma viscosity
- infections
ESR
- collagen vascular disease
CRP
- IBD
- tumours
X-ray
- bone tumours
- infection
- trauma
- avascular necrosis
- leukaemia
- slipped capital femoral epiphysis
Bone scan
- osteomyelitis
- stress fractures
- malignant tumours
Muscle enzymes
- damage to muscle cells
40
Compare characteristics in leg pain due to organic vs non-organic causes
Organic
- day and night persists
- interrupts play
- unilateral
- located in joint
- limp/refuses to walk
- systemic features
- O/E point tenderness, redness, swelling, limited movements, muscle weakness/atrophy, fever, rash, pallor, lymphadenopathy, organomegaly
Non-organic
- only at night
- primarily school days
- no interference w normal activities
- located between joints
- bilateral
- normal gait
- otherwise healthy child
- normal exam/minor changes such as coolness/mottling of leg
41
Investigations for a child with swollen joints and their relevance
FBC
- high WCC, left shift = bacterial infection
- anaemia in collagen vascular disease, IBD, malignancy
- haemoglobinopathy features
ESR + plasma viscosity
- elevated in bacterial infection, collagen vascular disease, IBD
Blood culture
- +ve septic arthritis
ASO titre
- indicative of strep infection = reactive arthritis
Viral titres
- viral arthritis
Rheumatoid factor, antinuclear antibodies
- -ve in most forms of juvenile chronic athritis
X ray
Joint aspiration
- microscope + culture for ?septic arthritis
42
Causes of abnormal gait
Common
- flat feet
- intoeing
- bow legs and knock-knees
- toe walking
Less common
- congenital dislocation of hip
- cerebral palsy
43
Name two paediatric forms of joint trauma
Pulled elbow/'nursemaid's' elbow
- sudden forceful traction on arm dislocates elbow
- toddler group, don't complain but refuse to use arm/hold in flexed position
- simple supinate arm fully to click head of ulnar back into place
Fracture of the growth plate
- most vulnerable structure in joint is growth plate > ligamentous sprain
- still present w swelling, not seen easily on X ray
- immobilise joint for few weeks
44
6 yr old comes in w 4/7 fever and 2/7 swollen knee
O/E swelling and redness at site, temperature 37.9
IX sterile aspirate, high WCC and ESR
What likely caused this and how should we treat?
Osteomyelitis
- Staph aureus
- Haem influenzae
- Strep pyogenes
Long bones infected, get sympathetic effusion of adjacent joint
High-dose abx for 4 weeks
Surgical exploration and drainage if no response to abx
45
Complications of osteomyelitis
Irreversible bone necrosis
Draining sinuses
Limb deformity
46
What clinical features would you expect in transient synovitis?
Sudden onset limp w hip and/or knee pain
Mild UTI/viral infection precedes sx
Limited abduction, extension + internal rotaion of hip
Lack of systemic sx
Normal WCC, ESR, hip X ray
47
Most common organisms causing septic arthritis
Staph aureus
Haem influenzae
*blood-borne*
48
What would the ix show in septic arthritis?
Elevated WCC, ESR, CRP
X ray shows widening of joint space due to fluid accumulation, adjacent osteomyelitis
Aspiration of joint sent for urgent microscopy + culture, fluid is purulent with organisms found on gram's stain
49
Tx for septic arthritis
IV flucloxacillin + penicillin/cephalosporin
Splint joint in acute stage
Switch to oral abx as systemic sx settle
Pain subsided, physiotherapy to encourage full joint mobility + avoid joint flexion deformities
50
8 yr old boy presents w pain in left hip and limp for 1/52
X ray shows increased density, flattening and fragmentation of left capital femoral epiphysis
What this and its tx?
Legg-Calve-Perthes disease/avascular necrosis of femoral head
Tx includes bracing or traction and recovery may take 2-3 years
51
12 yr old obese boy presents w pain in knee, gradually increasing over last week
What is likely seen on examination and X ray?
O/E hip held in abduction and external rotation with limitation of internal rotation
X ray shows slipped capital femoral epiphysis
52
What are the three presentations of juvenile idiopathic arthritis?
Systemic (M>F)
- large and small joints affected
- remitting fever, variable rash, anaemia, wt loss, abdo pain, hepatosplenomegaly
Polyarticular (F>M)
- large and small joints affected
- morning stiffness common
- symmetrically distributed
- sometimes poor wt gain and mild anaemia
Pauciarticular (F>M)
- <5 joints, usually large
- chronic iridocyclitis
53
What ix would you see in juvenile idiopathic arthritis?
Elevated ESR and WCC
Anaemia
RhF negative
ANA negative in systemic
ANA positive possible in poly-, pauciarticular
X ray: soft tissue swelling, periostitis, early loss of cartilage, bone destruction + fusion
54
How do you manage juvenile idiopathic arthritis?
NSAIDs for inflammation
Corticosteroids for severe systemic disease (avoid repeated steroid injections into joint)
Physio- and occupational therapy
Psychosocial support for child and family
55
Causes of anaemia/pallor in childhood
Common
- iron deficiency anaemia
- thalassaemia trait
Uncommon
- lead poisoning
- haemolysis, i.e. thalassaemia major, sickle cell
- chronic infection
- chronic renal failure
- malignancy, i.e. leukaemia
56
What ix would you do in a child with anaemia who is ill or unresponsive to iron treatment?
```
FBC
Blood film
Ferritin
Lead level - check for toxicity
Haemoglobin electrophoresis
U&Es
Blood and urine culture
Bone marrow aspiration
```
57
Why is anaemia common in toddlers?
Poor intake of iron-rich foods
| Cow's milk bottle feeding leads to occult GI blood loss
58
3 yr old comes in with irritability and pallor, started on iron treatment, however, has been unresponsive
Blood film shows hypochromic microcytic anaemia
X ray shows radiopaque flecks and increased density at growing ends of bone
What is this and its tx?
Lead poisoning
- high lead levels would have been tested irl
- radiopaque = foreign matter ingested
- long bones with increased density = leadlines
Sx
- usually subtle, irritability, decreased play, anorexia
- acute encephalopathy rare
Tx
- lead chelating agents
- source must be identified and removed
59
Complication of repeated iron transfusions and how are they managed
Haemosiderosis
- cardiomyopathy
- cirrhosisd
- diabetes
- skin pigmentation
Chelating iron agents to mop up extra iron
- desferrioxamine, subcutaneous/IV/oral
60
How is thalassaemia diagnosed?
Haemoglobin electrophoresis
| - beta thalassaemia = HbA1 absent, HbA2 + HbF increased
61
What would blood film of homozygous state of thalassaemia show?
Severe anaemia
- hypochromia, microcytosis
- fragmented poikilocytes
- target cells
62
What would you see on physical examination of a child with thalassaemia major?
```
Anaemia - pallor
Maxillary overgrowth - frontal bossing
Hepatosplenomegaly
Skin pigmentation - haemosiderosis
Short stature and delayed puberty
```
63
4 yr old comes in with painful swelling of hands and feet after a bout of gastroenteritis
O/E scleritis, dactylitis, splenomegaly
What's going on and what would you see on a blood smear?
Sickle cell disease, pts susceptible to acute, painful crises due to dehydration, hypoxia or acidosis
Blood smear
- target cells
- poikilocytes
- irreversibly sickled cells
64
Complications of sickle cell disease
Chronic haemolysis
Recurrent painful crises due to ischaemic occlusions
Aplastic crises
Sequestration crises causing circulatory collapse
Pneumococcal infection due to asplenism
Osteomyelitis
Renal damage w reduced ability to concentrate urine
Gallstones
Heart failure from chronic anaemia
65
Mx of child with sickle cell disease
Analgesics, abx, warmth, fluids during crises
Blood transfusion if Hb low during aplastic, sequestration or haemolytic crisis
Maintain immunisations, i.e. pneumococcal
Penicillin prophylaxis to prevent pneumococcal infection
Genetic counselling for family
66
How is sickle cell diagnosed?
Haemoglobin electrophoresis
| - HbS present, HbA absent
67
What is the main concern for children with asplenism and how are they managed?
Spleen responsible for filtering blood and early antibody responses so asplenic children at high risk of sepsis, particularly due to pneumococcal infection
- prophylactic penicillin
- maintain pneumococcal immunisation
68
10 yr old comes in with new onset rash, had viral infection 2 weeks ago, otherwise generally healthy
O/E petechial rash, superficial bruising on arms and legs
What will your ix show for most likely diagnosis?
Low platelet count < 40 x10^9/L
Normal WCC, Hb (anaemia only if significant blood loss occurring)
Bone marrow aspirate (to exclude aplastic/neoplastic bone marrow problems) show normal or increased megakaryocytes
69
What's the prognosis for ITP?
Fantastic - 85% self-limiting course
Severe spontaneous haemorrhage and intracranial bleeding confined to initial phase of disease then majority children recover within 6 months
Children with chronic ITP face splenectomy and immunosuppressive tx
70
5 yr old comes in with increased lethargy and wt loss over last couple months. Mum mentions recent fevers and irritability. Last week been complaining about left leg pain.
O/E petechiae, mucous membranes bleeding, lymphadenopathy, splenomegaly, bone tenderness in left leg
What will ix show likely show?
Peripheral blood smear
- elevated WCC
- anaemia
- thrombocytopenia
- blast cells may be seen
Bone marrow
- replaced by leukaemic lymphoblasts
71
What features would you expect to see in congenital rubella infection of a newborn?
Characteristic features:
- sensorineural deafness
- congenital cataracts
- congenital heart disease (i.e. PDA)
- glaucoma
Other features:
- growth retardation
- hepatosplenomegaly
- purpuric skin lesions
- 'salt and pepper' chorioretinitis
- microphthalmia
- cerebral palsy
72
What would you expect to see in congenital toxoplasmosis infection of a newborn?
Characteristic features:
- cerebral calcification
- chorioretinitis
- hydrocephalus
Other features:
- anaemia
- hepatosplenomegaly
- cerebral palsy
73
What would you expect to see in congenital cytomegalovirus infection of a newborn?
Characteristic features:
- growth retardation
- purpuric skin lesions
Other features:
- sensorineural deafness
- encephalitis/seizures
- pneumonitis
- hepatosplenomegaly
- anaemia
- jaundice
- cerebral palsy
74
What causes stridor?
Partial obstruction of the upper airway, causing an inspiratory noise
75
What causes wheeze?
Partial obstruction of the lower airway, causing an expiratory wheeze
76
Signs of respiratory distress
```
SOB
Tachypnoea
Alar flaring
Intercostal and subcostal recession
Use of accessory muscles for breathing
```
SEVERE SIGNS
Cyanosis
Drowsiness
Inability to talk
77
What age groups do the following conditions typically occur in?
a) croup
b) epiglottis
c) foreign body
d) laryngomalacia
e) subglottic stenosis
a) 6-24 months
b) 2-7 years
c) 9-18 months
d) newborn
e) 0-6 months
78
What are the distinguishing features between the following conditions?
a) croup
b) epiglottis
c) foreign body
d) laryngomalacia
e) subglottic stenosis
They all present with stridor
a) coryzal prodrome, barking cough
b) toxicity and high fever, drooling
c) hx and sudden onset stridor
d) at birth, nosy breather worse on crying and improves w age
e) previous hx of intubation, exacerbations with URTI
79
What are the developmental warning signs at any age?
Maternal concern
| Regression in previously acquired skilss
80
What are the developmental warning signs at 10 weeks?
Not smiling
81
What are the developmental warning signs at 6 months?
Persistent primitive reflexes
Persistent squint
Hand preference
Little interest in people, toys, noises
82
What are the developmental warning signs at 10-12 months?
No sitting
No double-syllable babble
No pincer grasp
83
What are the developmental warning signs at 18 months?
Not walking independently
Fewer than six words
Persistent mouthing and drooling
84
What are the developmental warning signs at 2.5 years?
No two- to three-word sentences
85
What are the developmental warning signs at 4 years?
Unintelligible speech
86
Causes of speech and language difficulties
```
Speech difficulties
Stammer
Cleft lip and palate
Deafness
Maturational delay (familial)
Environmental deprivation and neglect
Learning disabilities
Communication difficulties
Autism
Language disorder
```
87
Common causes of delayed walking
```
Delayed motor maturation (familial)
Severe learning diasabilties
Cerebral palsya
Hypotonia of any cause
Muscular dystrophy
Other neuromuscular disorders
```
88
What signs may you see on physical examination of the following patients with:
a) Trisomy 21
b) Fragile X
c) Fetal alcohol syndrome
d) Inborn errors of metabolism
e) Intrauterine infections
a) Epicanthic folds, small palpebral fissures, flat nasal bridge, single palmar crease, Brushfield spots, hypotonia
b) Long face, prominent ears, large jaw, large testes at puberty
c) Short palpebral fissures, maxillary hypoplasia, thin upper lip, microcephaly
d) Sometimes coarse features, hepatosplenomegaly, microcephaly, failure to thrive
e) Visual or hearing deficits common, microcephaly
89
What medication is used for ADHD in children?
Methylphenidate
90
Character and area affected in the brain by the following types of cerebral palsy:
a) Spastic
b) Dystonic
c) Ataxic
Spastic
- most common
- damage to cerebral motor cortex/its connections
- brisk deep tendon reflexes, clonus, hypertonia in affected limbs
Dystonic
- damage to basal ganglia
- irregular, involuntary movements that may be continuous/occur on voluntary movement
Ataxic
- rare
- damage to cerebellum
- hypotonia, incoordination and intention tremor
91
What features may be seen in the diagnosis of cerebral palsy in a 12-month old?
Abnormalities of tone
- initially reduced than spasticity develops
Delays in motor development
- marked head lag and delays in sitting and rolling over usually found
Abnormal patterns of development
Persistence of primitive reflexes
- Moro, grasp, and asymmetric tonic neck reflex persist
92
State the main features of spastic hemiplegia cerebral palsy
One side of the body affected, arm > leg, walking delayed until 18-24 months then characteristic gait noted - walks on tiptoes, affected arm held in dystonic posture when running
93
State the main features of spastic diplegia cerebral palsy
Survivor of severe prematurity, both legs involved > arms, problem when baby starts to crawl and legs drag behind, when baby suspended goes into scissoring position, walking delayed and child walks on tiptoes
94
State the main features of spastic quadriplegia cerebral palsy
Severe due to marked motor impairment of all extremities, associated with severe LD and fits, swallowing difficulties and GO reflux common, microcephaly
95
What teams are involved with children cerebral palsy?
```
Paediatricians
Physiotherapists
Occupational therapists
Speech therapists
Orthopaedic surgeons
Dieticians
Social workers (support family)
Special educational needs institutions (if severe)
```
96
Neurological signs seen in affected limbs of spastic cerebral palsy
Clasp-knife hypotonia
Brisk deep tendon reflexes
Ankle clonus
Babinski response (extensor plantar)
97
5 year old boy presents with a lordotic, waddling gait and difficulty climbing stairs.
O/E enlarged but weak calf muscles
What ix should you do and what would they show?
Elevated creatinine kinase levels
Further confirmatory ix:
EMG shows myopathic changes
Muscle biopsy
98
5 year old boy presents with a lordotic, waddling gait and difficulty climbing stairs.
O/E enlarged but weak calf muscles
What is the cause of their condition?
Duchenne muscular dystrophy is X-linked recessive trait
Only seen in boys
99
Mx of duchenne muscular dystrophy
Poor prognosis - life expectancy 20s-early 30s
Respiratory support with steroids or non-invasive breathing support overnight
Physiotherapy
Genetic counselling for future pregnancies
100
Clinical features of trisomy 21
```
Upward sloping palpebral fissures
Epicanthal folds
Brushfield spots
Protruding tongue
Flat occiput
Single palmar creases
Hypotonia
Small stature
```
101
Complications seen in trisomy 21
```
Cardiac anomalies (AV canal defects)
Duodenal atresia
Secretory otitis media
Strabismus
Hypothyroidism
Atlantoaxial instability
Leukaemia
Alzheimer's later in life
```
102
Which children are at risk for hearing impairment?
```
Severe prematurity
Hx of meningitis, recurrent otitis media
Significantly delayed/unclear speech
FHx of deafness
Parental suspicion of deagness
Children w cerebral palsy, cleft palate, absent/deformed ears
```
103
Common conductive hearing loss seen in children
Glue ear
- chronic secretory otitis media
- result of persistent effusions in middle ear
104
Surgical mx of conductive hearing loss in children
Grommets inserted
- aerates middle ear and drains fluid
- adenoidectomy may be performed at same time
- will eventually fall out spontaneously and don't need to be replaced as child grows out of glue ear
105
Mx of sensorineural hearing loss in children
Hearing aids
Aid communication (sign language, lip reading)
Education by peripatetic teacher of deaf to assist in mainstream schools
106
When are children's hearing tested?
Within few weeks of birth
- newborn hearing screening via automated otoacoustic emission (AOAE) test
- if no response from 1st test goes onto have automated auditory brainstem response (AABR) test
9 months to 2.5 years old
- reviews will be asked, parental concern will lead to hearing test referrals
4 to 5 years old
- hearing tests when you start school depending on where you live
107
What are 'blindisms'?
Children with visual deficits develop mannerisms like eye poking, eye rubbing and rocking
Likely as it may induce pleasurable visual gratification of retinal origin
108
Commonest causes of visual impairment in children
Optic atrophy
Congenital cataracts
Choroidoretinal degeneration
109
How may development be affected in a child with visual impairment?
If congenital, early smiling is inconsistent and no turning towards sounds
Reaching for objects and pincer grip is delayed
Early language may be normal but complex language may be delayed
110
What is diurnal enuresis?
Lack of bladder control during the day in a child old enough to maintain bladder continence
111
Features suggestive of a neurogenic bladder
Distended bladder
Abnormal perianal sensation and anal tone
Abnormal neurological findings in the legs
112
Features suggestive of congenital bladder anomalies
Primary enuresis
Continuous leakage of urine
Distended bladder
UTI in preschool years
113
What urinary sx points towards a psychogenic cause?
If sx are absent at night, psychogenic likely (although the opposite cannot be stated)
114
What ix could you do for haematuria and why?
Urinalysis
- red cell casts, protein ++ indicate glomerular lesion
- pyuria, bacteriuria indicate infection
Urine culture
- UTI
FBC
- anaemia
ASO titre and throat culture
- recent strep infection precedes acute glomerulonephritis
Serum creatinine, U&E
- elevated indicate impaired renal function
24-hour urine creatinine, protein and calcium
- Cr clearance quantify renal impairment
Serum C3 level
- low C3 specific for some glomerulonephritis
Abdo/pelvic US and intraveous pyelogram
- structural abnormalities of kidney
Renal biopsy
- if persistent haematuria with proteinuria, hypertension or impaired renal function
115
Possible ddx if you find renal mass on palpation
Hydronephrosis
Polycystic kidneys
Wilms' tumour
116
Causative organism of UTIs in children
90% E coli
117
When would you give IV abx for UTI in children?
< 3 months of age
| Older children w signs of systemic illness
118
1st line abx for UTI in children
Trimethoprim for 3 days for lower urinary tract
| 7-10 days if upper urinary tract involved
119
Which children with UTIs require further ix?
< 6 months old w single confirmed UTI need USS
Atypical/recurrent UTIs any age need USS
If persistent proteinuria with sterile urine need creatinine clearance to assess renal function
120
What does a DMSA do?
Radionuclide scan that uses dimercaptosuccinic acid (DMSA) in assessing renal morphology, structure and function
Detect renal scarring
121
What does a MCUG do?
Micturating cystourethrogram
- indicated < 6 months or older children when concerns about bladder neck outflow and vesicoureteric reflux
- unpleasant procedure requiring catheterisation
122
When would you do a DMSA and MCUG?
Atypical UTI
- DMSA 4-6 months later
- MCUG if < 6 months old
Recurrent UTI
- DMSA 4-6 months later
- MCUG if < 6 months old
123
What is VUR?
Vesicoureteric reflux
- reflux of urine from bladder up ureter on micturition due to incompetence of valvular mechanism at vesicoureteric junction
- more severe VUR can reflux back into kidney
- increased risk of renal scarring
124
Complications of VUR
Renal scarring (> 50%)
Hypertension in adult life (10-20%)
Chronic renal failure (less common)
125
Mx of VUR
Long-term prophylactic abx
Regular monitoring of renal growth
Surgery if severe reflux
126
Mx of nocturnal enuresis
Fluid restriction in evenings
Lift child from bed to urinate at night
Star charts (positive reinforcement)
Enuresis alarm (reserved if child motivated/indepdenent)
Vasopressin (can be used for an occasion, i.e. sleepover)
127
Smoky/cola-coloured urine is suggestive of which renal condition?
Acute glomerulonephritis
128
Signs and sx of acute glomerulonephritis
```
Smoky/cola-coloured urine
Malaise/headache
Loin discomfort
Throat/skin infection 2-3 weeks ago
Oedema (periorbital, backs of hands/feet)
Hypertension
```
129
Complications of acute glomerulonephritis
Renal failure
Hypertension
Seizures
Heart failure
130
Pt comes in with proteinuria, hypoproteinaemia, oedema, and hyperlipidaemia
What is this?
Nephrotic syndrome
131
What do you see in nephrotic syndrome?
Proteinuria, hypoproteinaemia, oedema, and hyperlipidaemia
132
Most common cause of nephrotic syndrome in children
Minimal change disease (85% cases)
133
Mx of nephrotic syndrome in children
Excessive fluid intake discouraged
No added salt diet
Daily weights and proteinuria
Steroids for 4-6 weeks
Prophylactic penicillin due to risk of infection (antibodies lost in urine)
Renal biopsy ONLY if child resistant to steroid tx
134
What medications may you use for sx in cerebral palsy?
Muscle stiffness = baclofen
Constipation = movicol
Sleeping problems = melatonin
Drooling = anti-cholinergic (scopolamine: hyoscine)
135
Clues to differentiate between a hydrocele, inguinal hernia, and testicular torsion
Hydrocele
- transilluminates, not painful, more likely in babies
Inguinal hernia
- infants (usually premature), extends to groin, not painful
Torsion
- very painful, boys under 6 usually
136
Causes of scrotal swellings
Hydrocele
Inguinal hernia
Testicular torsion
137
Causes of swelling in the groin
Inguinal hernia
Inguinal lymphadenopathy
Ectopic testis
138
Causes of impalpable testes
Undescended or ectopic testes
Retractile testes
True testicular absence
139
6 week baby check, undescended testes noted - when should the baby have surgery?
May descend spontaneously before 1 year
Must have surgery before age of 2 years to reduce complications
140
What testing should be done if testes are impalpable bilaterally?
Chromosomal and hormonal testing
| ?Intersex
141
What complications arise due to cryptochordism?
Uncorrected undescended testes can result in infertility and malignancy
142
4 yr old boy comes in acute pain and swelling of the scrotum
O/E distressed, scrotum looks tender and swollen
What are the next steps?
Surgical exploration for testicular torsion to untwist and fix testis to scrotum
If completed within 6 hours, greater chance of testis surviving
If testicular torsion confirmed, contralateral testis must be fixed as also prone to torsion
If Hydatid of Morgagni, contralateral testis does not need to be fixed
143
When is an irretractable prepuce pathological?
After 3 years of age it is considered true phimosis and requires surgery
144
What is the most common hypospadias?
Meatus sited on the ventral aspect of the glans penis
145
When should surgical reconstruction occur for hypospadias?
Before the age of 2 years
146
What should parents be advised if their baby has a hypospadias?
Do not circumcise the child as the foreskin may be used in reconstructive surgery
147
Complications of an inguinal hernia
Risk of strangulation of bowel and/or testis
148
Features of an atypical UTI
```
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms
```
149
Describe a macule lesion, including examples
Discrete flat lesions of any size or shape that are pink/red in colour
Characteristically fade on pressure
- rubella, roseola
150
Describe a papule lesion, including example
Solid palpable projections above the surface of the skin
- insect bite
151
Describe a maculopapular lesion, including examples
Mixture of macules and papules which tend to be confluent
- measles, drug rash
152
Describe a purpura and petechiae lesion, including examples
Purple lesions caused by small haemorrhages in the superficial layers of skin, indicating a serious condition
Characteristically DO NOT fade on pressure
Petechiae - tiny purpuric lesions
- meningococcal septicaemia, ITP, HSP, leukaemia
153
Describe a vesicle lesion, including example
Raised fluid filled lesions < 0.5cm in diameter, if larger they are bullae
- chicken pox
154
Describe a wheals lesion, including example
Raised lesions with a flat top and pale centre of variable size
- urticaria
155
Describe a desquamation lesion, including example
Loss of epidermal cells producing a 'scaly' eruption
- post-scarlet fever
156
2 year old presents with non-blanching purpuric rash with a background of 2 days fevers of up to 39 degrees
What ix should you order?
Suspected meningococcal septicaemia needs urgent ix:
- Blood cultures
- Meningococcal PCR
- Clotting screen
- FBC
- Ca profile
157
2 year old presents with non-blanching purpuric rash with a background of 2 days fevers of up to 39 degrees
What mx should be given?
Immediate IM penicillin + urgent hospital admission with extensive ix
158
Maculopapular rash starts on face then spreads downwards, what other features may you see in this child?
Measles
- koplik spots
- coryza
- cough and conjunctivitis
- ill child
159
Tiny pink macular rash starts on face and trunk and works downwards, what other features may you see in this child?
Rubella
- well child
- lymphadenopathy sometimes
160
Macular faint pink rash presents on trunk, what other features may you see in this child?
Roseola
| - rash occurs after fever defervesces
161
Fine punctuate maculopapular rash with a sandpaper feel starts to peel, what other features may you see in this child?
Scarlet fever
- strawberry tongue
- perioral pallor
- tonsillitis
162
Maculopapular lace-like rash present on arms, trunk and thighs, what other features may you see in this child?
Fifth disease
- 'slapped cheek'
- well child
- lasts up to weeks
163
Papules, vesicles and crusts present in crops on face and trunk, what other features may you see in this child?
Chicken pox
| - shallow ulcers of the mucous membranes
164
Compare the presentations seen in HSP and ITP
HSP
- purpuric
- distributed over buttocks, thighs and legs
- abdo pain, arthralgia, melaena, haematuria
ITP
- petechial over body
- bruising present
- bleeding from other sites, i.e. gums, nose
165
Common chronic skin rashes in children
Eczema (atopic dermatitis)
Contact dermatitis
Seborrhoeic dermatitis
Psoriasis
166
What can long-term topical steroid use result in?
Atrophy of skin
Increase in hair growth
*particularly the fluorinated variety of steroids
167
Compare the distribution of common chronic skin rashes in children
Atopic dermatitis
- flexures
Contact dermatitis
- at sites of contact with irritant
Seborrhoeic dermatitis
- face, neck, axillae and nappy area
Psriasis
- scalp, knees, elbows and genitalia
168
Causes of nappy rash
Ammoniacal dermatitis
Candidiasis
Seborrhoeic dermatitis
Psoriasis
169
Describe a typical ammoniacal dermatitis nappy rash
Erythematous +/- papulovesicular/bullous lesions, fissures and erosions
Patchy/confluent
Skin folds characteristically spared
170
Describe a typical candida nappy rash
Bright red with sharply demarcated edge and satellite lesions
Inguinal folds involved
Oral thrush may be found
171
Compare nappy rashes caused by seborrhoeic dermatitis and psoriasis
BOTH
- pink, greasy lesions with yellow scale
- often in skin folds
SD
- cradle cap may be found
Psoriasis
- +ve FHx
- nail pitting present
172
Roughened keratotic lesion with irregular surface on finger of 8 year old
Wart
173
Sticky, heaped-up, honey-colour crusts in flexures of 3 year old with known eczema
Impetigo
174
Pearly, dome-shaped papules with central umbilicus on trunk of 6 year old
Molluscum contagiosum
175
Dry scaly papule which spreads centrifugally with central clearing on 9 year old's back
Tinea corporis (ringworm)
176
Grouped vesicles and pustules on upper lip of 5 year old
Cold sore
177
When could guttate psoriasis occur?
Post-streptococcal infection
178
Mx of nappy rash
Regular changing and washing area
Exposure to air
Protective creams (i.e. zinc and castor oil ointment)
Consider use of mild hydrocortisone cream, anticandida creams (nystatin)
179
Main pathogens responsible for impetigo
Group A haemolytic streptococci or staphylococci
180
Mx of impetigo
< 5 lesions = topical abx
| > 5 = oral abx (erythromycin, broad cover)
181
Medication used to treat extensive ringworm
Griseofulvin
182
Treatment for threadworms
Single doze mebendazole for whole household
183
List potential birthmarks and what they may signify
Pigemented naevi = rarely malignant, appear from 2 yo
Cafe-au-lait spots = neurofibromatosis
Strawberry naevus = resolve spontaneously, only treat if affecting vision
Naevus flammeus = stork marks/salmon patch, resolve spontaneously
Mongolion spots = fade during first years of life
Port-wine stain = localised to trigeminal area, potential Sturge-Weber syndrome
184
What is associated with Sturge-Weber syndrome?
Port-wine stain on trigeminal area of face
Underlying meningeal haemangioma
Intracranial calcification associated with fits
185
Types of child abuse
```
Physical neglect
Emotional abuse
Non-accidental injury
Sexual abuse
Non-organic failure to thrive
```
186
Characteristics of non-accidental injury
Injuries in very young children
Explanations which do not match the appearance of the injury and sound unconvincing
Multiple types and age of injury
Injuries which are 'classic' in site or character
Delay in presentation
Things the child communicates during the evaluation
187
Fractures associated with NAIs
Spiral fractures
Metaphyseal chips
Periosteal bleeds
Callus around ribs
188
Clinical features of physical abuse
```
Physical neglect
Failure to thrive
Bruises
Fractures
Burns and scalds
Bites
Ligature marks
```
189
Ix in suspected child abuse
Photographs
- useful for further consultation and evidence in court
FBC, PTT, APTT
- rule out thrombocytopaenia or other haem disorders causing excessive bruising
```
Skeletal survey (X-rays)
- characteristic fractures and healing at various stages suggestive of NAIs
```
Head CT scan
- important in infants presenting with abuse, detect subdural haemorrhage which could be missed
Pregnancy test, STI screen
- in children suspected of sexual abuse, STI +ve strong corroborative evidence + needs treatment
190
General mx for suspected child abuse
Medical care for injury
Involve social services
Admit child to place of safety if ongoing danger
Case conference
Child Protection Register
Removal from home if child remains at risk
191
Triad of shaken baby syndrome
Retinal haemorrhages
Subdural haematoma
Encephalopathy
192
Features of focal seizure of the following:
a) Temporal
b) Occipital
c) Frontal
d) Parietal
Temporal
- aura including strange tastes or smells before the seizure
- automatisms (lip smacking, plucking at clothes, aimless walking)
- consciousness may be impaired and a feeling of deja vu has been described
Occipital
- hallucinations or visual deficits
Frontal
- may cause proximally moving clonic movements (Jacksonian march) or tonic seizures of one or both upper limbs
Parietal
- contralateral altered sensation or distorted body image
193
Asthma guidelines for 5-16 year olds
```
SABA alone
SABA + low dose ICS
SABA + low dose ICS + LTRA
SABA + low dose ICS + LABA
MART with low dose ICS
MART with moderate dose ICS OR SABA + moderate dose ICS + LABA
```
194
What ix would you do in infants younger than 3 months with fever?
Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present
195
What criteria is used to assess the probability of septic arthritis in children?
```
Kocher's criteria (1 point each):
Non-weight bearing
Fever > 38.5ºC
WCC > 12 * 109/L
ESR > 40mm/hr
```
0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis
196
What is the most common cause of secondary skin infection to chicken pox lesions?
Invasive group A streptococcal (Strep pyogenes)
| - results in soft tissue infections may occur resulting in necrotizing fasciitis
197
First signs of puberty
Boys
- testicular enlargement
Girls
- breast budding
198
What are the key ages for the following in puberty?
a) Normal puberty start to completion
b) Precocious puberty
d) Delayed puberty
d) Delayed menarche
a) B: 11-16yo; G: 10-14yo
b) B: < 9.5yo; G: < 8.5 yo
c) B: > 14yo; G > 13 yo
d) G: > 16yo
199
What pain is seen in Osgood-Schlatter disease?
Unilateral (but may be bilateral in up to 30% of people).
Gradual in onset and initially mild and intermittent, but may progress to become severe and continuous.
Relieved by rest and made worse by kneeling and activity, such as running or jumping.
200
What's raised in biliary atresia?
Conjugated bilirubin
201
Amber signs in the traffic light system
```
Nasal flaring
Lung crackles on auscultation
Not responding normally to social cues
Reduced nappy wetting
Dry mucous membranes
Pallor reported by parent or carer
```
202
Red signs in the traffic light system
```
Moderate or severe chest wall recession
Does not wake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting
```
203
Gross motor limit ages
4 months - head control
9 months - sits unsupported
12 months - stands with support
18 months - walks independently
204
Vision and fine motor limit ages
3 months - fixes on objects and follows them visually
6 months - reaches for objects
9 months - transfers objects between hands
12 months - has developed a pincer grip
205
Hearing, speech, and language limit ages
```
7 months - polysyllabic babble
10 months - consonant babble
18 months - can say 6 words with meaning
2 years - joins words together
2.5 years - 3-word sentences
```
206
Social behaviour limit ages
```
8 weeks - smiles
10 months - fears strangers
18 months - can feed self with a spoon
2-2.5 years - symbolic play (e.g. pretending a wooden block is a car/ phone)
3-3.5 years - Interactive play
```
207
What sign is seen on USS for duodenal atresia?
'Double bubble' sign
- refers to the pockets of air in the proximal duodenum and stomach separated by the pyloric sphincter
- distal to the point of atresia, there will be no air visible in the duodenum
208
Tx in suspected meningitis
Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
No steroids in < 3 months
Fluids
Cerebral monitoring
Public health notification + abx prophylaxis for close contacts
209
When should you trial PPI in infants with GORD?
Trial in infants with GORD who do not respond to alginates/thickened feeds and who have:
1. feeding difficulties
2. distressed behaviour or
3. faltering growth
210
Signs of severe illness in a child
```
Rashes (petechial, purpuric)
Deep coma, can't arouse them
Dehydrated
Respiratory distress
Stridor
Signs of injury
Large surface area of burns
```
211
Mx of respiratory failure
Regular ABGs
Oxygen sat monitor and if desaturating give oxygen
If PaCO2 increasing, mechanical ventilation required on ITU
Find underlying cause: CXR
Treat underlying cause: abx, steroids, bronchodilators, remove foreign body
212
Causes of upper airway obstruction
Intrinsic: epiglottis, croup
Extrinsic: foreign body
213
What is 'shock'?
Term used to describe a state where the cardiac output is insufficient to perfuse the tissues adequately
214
Mx of shock
IV cefotaxime if meningitis suspected
Rapid IV fluid bolus 20ml/kg irrespective of cause
Blood to replace haemorrhagic loss
Monitor fluid replacement by central venous pressure line
Inotropes if cardiac performance impaired
Treat underlying cause
Monitor in ITU
Treat complications: coma, renal failure
215
Clinical features of shock
```
Restlessness
Tachycardia
Thready pulse
Tachypnoea
Mottled pale cold skin
Clammy extremities
Hypotension (late finding)
Oliguria
Metabolic acidosis
```
216
Hexosaminidase A deficiency
Tay-Sachs disease
- NO hepatomegaly
- cherry-red spot on macula
- neurodegeneration
217
Alpha-galactosidase A deficiency
Fabry's disease
218
Alpha-L-iduronidase deficiency
Hurler syndrome
219
Sphingomyelinase deficiency
Niemann-Pick's disease
- hepatomegaly
- cherry-red spot on macula
- neurodegeneration
220
Glucocerebrosidase deficiency
Gaucher's disease
221
AVPU score
A: alert
V: responds to voice
P: responds to pain
U: unresponsive
222
Emergency tx of convulsing child
Check airway
Lay child on floor in recovery position
Do not insert objects into child's mouth
Child needs medication to abort seizure if lasts longer than 5 minutes
223
Indications to perform a CT head (name six)
GCS < 15 at 2 hours after head injury
Suspicion of NAI
Post-traumatic seizure in absence of epilepsy
Suspected open/depressed skull fracture/tense fontanelle in bebe
Signs of basal skull fracture
< 1 years old with bruise/swelling/laceration on heard > 5cm
Focal neurological deficit
GCS < 14 or < 15 if < 1 yo on arrival to A&E
LOC lasting > 5 mins
Abnormal drowsiness
3+ discrete episodes of vomiting
Dangerous mechanism of injury (RTA)
Amnesia lasting > 5 minutes
224
Risk factors for SIDS
```
Birth weight < 2.5kg
Socioeconomic deprivation
Premature birth < 37 weeks
Parental smoking, esp if mother during pregnancy
Co-sleeping
High environmental temperature
Sleeping in prone position
Bottle feeding
Non-use of pacifier
```
225
Muco-active agents for CF
Lumacaftor (Potentiator)
Ivacaftor (Corrects)
*new agents
226
Evidence of serious chronic lower respiratory tract disease in children
```
Productive cough which improves with abx but quickly recurs
Restriction of activity
Failure to grow or gain weight
Nail clubbing
Persistent tachypnoea
```
227
What sounds are heard with partial obstruction of the upper and lower airways?
```
Upper = inspiratory stridor
Lower = expiratory wheeze
```
228
What age do you see the following resp conditions?
a) Croup
b) Epiglottis
c) Foreign body
d) Laryngomalacia
e) Subglottic stenosis
a) 6-24 months
b) 2-7 years
c) 9-18 months
d) newborn
e) 0-6 months
229
Main causes of pneumonia in children
Bacteria
- Strep pneumoniae
- Mycoplasma pneumoniae
- Haem influenzae
- Group B strep in newborn
Viral
- RSV
- Influenza/parainfluenza
- Adenovirus
230
Which conditions require no exclusion from school?
```
Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
```
231
What are the school exclusion rules for the following conditions?
a) Scarlet fever
b) Measles
c) Rubella
d) Chickenpox
e) Mumps
f) Whooping cough
g) Influenza
h) Scabies
i) D&V
a) 24 hours after commencing abx
b) 4 days from onset of rash
c) 5 days from onset of rash
d) Lesions all crusted over (usually about 5 days from onset of rash)
e) 5 days from onset of swollen glands
f) 2 days after commencing abx (or 20+1 days from onset of sx if no abx)
g) until recovered
h) until treated
i) sx settled for 48 hours
232
Worrying features in a vomiting child
```
Bile-stained vomitus
Blood in vomitus
Drowsiness
Refusal to feed
Malnutrition
Dehydration
Abdominal tenderness or distension
Abdominal mass
Encephalopathy
Rectal bleeding
```
233
Features of concern in a child with headache
```
Acute onset of severe pain
Fever
Headache intensified by lying down or waking during night
Associated nightmare
Diminished school performance or regression of developmental skills
Consistently unilateral pain
Cranial bruit
Hypertension
Papilloedema
Fall-off in growth
```
234
Raised intracranial pressure headache features
```
Worse on lying down
Headaches worse in mornings
Wake up at night from pain
Vomiting without nausea
High BP, irregular breathing, papilloedema, enlarging head circumference
```
235
Notable EEG features for the following types of childhood epilepsy:
a) West Syndrome
b) Absence
c) Myoclonic
d) Centro-Temporal spike/rolandic
a) hypsarrhythmia
b) 3-3.5 per second spike and wave during seizure
c) polyspikes
d) spikes in 'rolandic' or centro-temporal spike
236
O/E hydrocephalus
```
Accelerated head growth
Open, bulging fontanelle
Separated sutures
'Setting sun' eyes
'Cracked pot' sound on skull percussion
Transillumination of the skull
Spasticity, clonus, brisk tendon reflexes
```
237
When may you be concerned about a child's growth?
After 2 years of age
- crossing of two centiles
- very short/very tall
- discrepancy between height and weight/parental heights
- parental/professional concern
238
Signs of congenital hypothyroidism
```
Coarse facies
Hypotonia
Bradycardia, hypotension
Macroglossia
Umbilical hernia
Constipation
Prolonged jaundice
Hoarse cry
Poor growth
Developmental delay
```
239
Scenarios where health professionals must be trained in neonatal resuscitation
```
Preterm birth
Fetal distress
Thick meconium staining of amniotic fluid
Emergency C section
Vacuum or forceps delivery
Major fetal abnormality
Multiple birth
```
240
Apgar Score
Heart rate
- 0: absent; 1: < 100/min; 2: > 100/min
Resp rate
- 0: absent; 1: weak cry; 2: strong cry
Muscle tone
- 0: limp; 1: some flexion; 3: good flexion
```
Reflex irritability (suction pharynx)
- 0: no response; 1: some motion; 2: cry
```
Colour
- 0: pale/white; 1: blue/cold periphery; 2: pink/perfused all over
241
Neonatal BLS
Assess
Five inflation breaths
Assess
3:1 cardiac compressions with ventilation ratio
Still no response consider venous access and administration of adrenaline as you await NICU transfer
242
Reflexes assessed at neonate exam
Moro
Grasp
Suck
Rooting
243
Risks of premature babye
```
Hypothermia
Hypoglycaemia
Jaundice
Infection
Respiratory distress syndrome
NEC
Retinopathy of prematurity
Intracranial haemorrhage
Feeding difficulties
```
244
Prenatal infectiosn
```
TORCH
Toxoplasmosis
Other (syphilis)
Rubella
CMV
Herpes
```
245
Unconjugated hyperbilirubinaemia causes of neonatal jaundice
```
Rhesus and ABO incompatibility
G6PD deficiency
Bacterial infection
Excessive bruising
Internal haemorrhage
Prematurity
Hypothyroidism
Breast-milk jaundice
Phsyiological
```
246
Conjugated hyperbilirubinaemia causes of neonatal jaundice
Neonatal hepatitis
Cystic fibrosis
Biliary atresia
247
Neonate has bile-stained vomit and 'double bubble' seen on AXR
Duodenal atresia
248
Anatomical abnormality causes of bowel obstruction in neonate
Oesophageal atresia
Duodenal atresia
Jejunal atresia
Anal atresia/imperforate anus
249
Functional abnormality cases of bowel obstruction in neonate
Hirschsprung's disease
Meconium ileus
Volvulus secondary to malrotation
250
CXR shows air bronchogram and ground glass appearance of lung fields of a neonate
Respiratory distress syndrome
