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Paeds Flashcards

1
Q

Abdominal wall defects

A

Omphacoele- sealed in a sac

Gastrochisis- no peritoneal sac, lots of fluid loss

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2
Q

What is the diagnosis of a preterm 2 week old which is crying, abdo distension, bloody stool?

A

Necrotising enterocolitis

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3
Q

What Ix do you do for NEC?

A

Cultures, FBC, blood gas
CRP
Diagnosis is made by AXR

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4
Q

What is the management of NEC

A

Frrd

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5
Q

Causes of LBO in a newborn?

A

Rectal atresia

Hirschsprungs

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6
Q

What is hirschsprungs disease?
How do you diagnose?
How do you treat?

A

Absence of ganglion cells from the myenteric and submucosal plexuses

Occurs in 1/5000 births

Full thickness rectal biopsy for diagnosos

Delayed passage of meconium and abdo distension

Treatment is with rectal washouts followed by anorectal pull through procedure

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7
Q

How would you manage suspected haematological malignancy?

A 
Any of the following features in a person aged 0-24 years should prompt a very urgent full blood count (within 48 hours) to investigate for leukaemia:
Pallor
Persistent fatigue
Unexplained fever
Unexplained persistent infections
Generalised lymphadenopathy
Persistent or unexplained bone pain
Unexplained bruising
Unexplained bleeding
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8
Q

What is a cephalohaematoma?

A

Swelling due to birth

doesnt cross suture lines

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9
Q

what is caput succedaum?

A

swelling, crosses suture lines

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10
Q

What is turners associated with?

A

Bicuspid aortic valve causing aortic stenosis and ejection systolic murmur

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11
Q

What does croup present with?

A

Stridor
Barking cough
Mild pyrexia
Coryzal sx

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12
Q

What is the cause of croup?

A

URTI caused by parainfluenza virus

Peak incidence 6 months- 3 years

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13
Q

When should a child be admitted with croup?

A

<6months of age
Known upper airway abnormalities- laryngomalacia, downs
uncertainty about diagnosis
Moderate or severe croup

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14
Q

How do you treat croup?

A

CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Prednisolone is an alternative if dex is not available

Emergency treatment; high flow oxygen, nebulised adrenaline

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15
Q

When should you never examine a childs throat?

A

In croup!

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16
Q

What should you do if a baby is jaundice in the first 24 hours of life?

A

You have to urgently measure and record the serum bilirubin level urgently (within 2 hours) in all babies with suspected or obvious jaundice as this is likely to be pathological rather than physiological jaundice

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17
Q

What are the causes of jaundice in the first 24 hours of life?

A

Rhesus haemolytic disease
ABO haemolytic disease
Glucose 6 phosphodehydrogenase
hereditary spherocytosis

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18
Q

What are the causes of jaundice from 2-14 days?

A

usually physiological
less developed liver, more RBC, fragile RBC
more common in breastfed babies

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19
Q

What Ix to do in prolonged jaundice (>14 days?)

A

14 days or 21 days premature, a perolonged jaundice screen is performed

Conjugated and unconjugated bilirubin (very improtant as raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention)

Coombs test (Direct antithyroglobulin test)

FBC

TFTS
Urine for MC+s and reducing sugars

UES

LFTS

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20
Q

What are the causes of prolonged jaundice?

A 
Biliary atresia 
Hypothyroidism 
Galactosaemia 
UTI 
breast milk  jaundice 
Prematurity 
CMV/Toxoplasmosis
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21
Q

What is scarlet fever?

A

A reaction to erythrogenic toxins produced by group A haemolytic streptococci (Staph pyogenes)
Spread via. the resp route by inhaling/ingesting resp droplets

Fever, malaise, headache, nausea, vomiting, sore throat, strawberry tongue, sandpaper rach

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22
Q

How do you manage scarlet fever?

A

Oral pen V for ten days
Azithromycin for pen allergy
Children can return to school 24 hours after commencing abx
Scarlet fever is a notifiable disease

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23
Q

What is the no.1 cause of painless massive GI bleeding requiring a transfusion in children aged 1-2?

A

Meckles diverticulum

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24
Q

What is VUR diagnosed by?

A

MCUG

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25
Q

What should be given to women who test positive for GBS on vaginal swabs or urine dip?

A

IV benzylpenicillin in labour

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26
Q

How does the Centor criteria work?

A 
Used for tonsillitis to estimate whether it is bacterial or viral and whether antibiotics will work 
CAFE
C= absence of cough 
A= Anterior cervical lymphadenopathy 
F= Fever (present) 
E= Exudate

If 3/4 are present then there is 40-60% chance the kid has Group B strep and needs antibiotics

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27
Q

How do you treat Group B strep tonsilitis?

A

Penicillin V for 5-10 days

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28
Q

How do you treat UTIs in kids?

A

If they are 3months- 12 years then cefalexin
If they are 12-17 years then nitrofurantoin
3 days!

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29
Q

What are the indications for ultrasound in urinary tract infections?

A

If they are younger than 6 months then they should all have one in 6 weeks

If they have atypical UTIs; seriously ill, poor urine flow, abdo or bladder mass, raised serum creatinine, failure to respond to suitable abx within 48 hours, infection with non E coli organisms

Recurrent UTI; > or equal to upper UTIS/ pyelonephritis, 1 upper UTI + > or equal to 1 lower UTI, > or equal to 3 UTIs/cusyotos

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30
Q

How can you prevent a kid from getting a UTI?

A 
Stay hydrated 
use the potty more often 
time the kids potty times 
empty bladder completely 
proper wiping (front to back) 
avoid constipation 
clothing choices- cotton underwear, avoid nylon, synthetic and tight fitting underwear
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31
Q

Whats the difference between simple and complex seizures in kids?

A

simple= <15 mins
Generalized seizure
No recurrence within 24 hrs

Complex=
>15 mins
focal
may have repeat in 24 hrs

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32
Q

What causes bile stained vomit and distended abdomen in a child?

A

Intestinal malrotation

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33
Q

What would the diagnosis be if a 4-6 week old has projectile non bilious vomiting and weight loss alongside a palpable mass?

A

hypertrophy of the pyloric stenosis

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34
Q

What does hypochloraemic metabolic alkalosis suggest?

A

Hypertrophy of the pyloric sphincter

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35
Q

How do you diagnose pyloric stenosis?

A

USS

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36
Q

How do you treat pyloric stenosis?

A

Ramstedt pyloromyotomy

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37
Q

What is intussusception and how does it present?

A 
telescoping of the bowel proximal to the ileocaecal valve 
presents at 6-9 months 
sausage shaped mass 
colicky pain, diarrhoea, vomiting
redcurrant jelly stool
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38
Q

How do you treat intussuseption?

A

Reduction w/ air insufflation

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39
Q

What does congenital rubella present with?

A

sensironeural deafness and congenital cataracts

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40
Q

What is croup?

What is it caused by?

A

URTI with laryngeal oedema and secretions which cause a stridor
Parainfluenza virus

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41
Q

What are the features of croup and how do you treat it?

A

Stridor, barking cough worse at night, fever, coryzal sx

Single dose of dex- 0.15mg/kg (pred if not)
emergency treatment is O2 and neb adrenaline

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42
Q

What are the causes of stridor in children?

A

Croup
Acute epiglottitis (caused by haemophilus influenzae type B)
Inhaled FB
Laryngomalacia (present at 4 weeks)

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43
Q

What are the features of PDA and how do you treat?

A 
Left subclavicular thrill 
continous machinery murmur 
large volume, bounding, collapsing pulse 
wide pulse pressure 
heaving apex beat

Indomethacin (Inhibits prostaglandin synthesis)

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44
Q

What murmur would you hear with Teratology of fallor?

A

ejection systolic

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45
Q

What causes meningitis in children?

A

Neonatal to 3 months=
Group B streptococcus

1 month to 6 years=
Neisseria meningitidis

> 6 years=
Neisseria meningitides
Strep pneumonia

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46
Q

Whats the difference between gastrochisis and exopthalmos?

A

exopthalmos covered by amniotic sac

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46
Q

Whats the difference between gastrochisis and exopthalmos?

A

exopthalmos covered by amniotic sac

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47
Q

What is kawasaki and what causes it?

What are the features?

A

Its a type of vasculitis

High grade fever which lasts for >5days, CHARACTERICALLY RESISTANT TO ANTIPYREXIALS
conjunctival injection
bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
red palms on hands and sole of feet which later peel

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48
Q

What is the management of kawasaki?

A

High dose aspirin
IV immunoglobulin
Echocardiogram to look for coronary artery aneursyms

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49
Q

What is used to assess the probability of septic arthritis in children?

A

Kochers

50
Q

What does kochers criteria involve?

A

High WCC
High ESR
High fever
Non weight bearing

51
Q

What are the signs and symptoms of septic arthritis?

A 
Symptoms= joint pain, limp, fever, lethargy 
Signs= Swollen red joint with limited movement

Do joint aspiration for culture (will show raised WCC)
Blood cultures

51
Q

What are the signs and symptoms of septic arthritis?

A 
Symptoms= joint pain, limp, fever, lethargy 
Signs= Swollen red joint with limited movement

Do joint aspiration for culture (will show raised WCC)
Blood cultures

52
Q

What is perthes disease?
What is the classical presentation?
What are the complications?
Management?

A

idiopathic avascular necrosis of the femoral head
Limp in a 4-8 year old boy with an irritable hip, limp and reduced range of movement despite no hx of trauma or systemic symptoms (5x more common in boys)
OA, premature fusion of growth plate
Under 6- observe, if older then surgery, cast/braces

53
Q

What are the two types of enuresis?

A

Primary- the child never achieved continence

Secondary- the child has achieved continence and been dry for 6 months before

54
Q

What are the management options for enuresis?

A

Reward systems
Enuresis alarm
Desmopressin

55
Q

What are the features of respiratory distress?

A

Intercostal and subcostal recession
Tracheal tug
Nasal flaring
Accessory muscles

56
Q

What are the risk factors for developmental dysplasia of the hip?

A

Female
Breech
FHX
Oligohydramnios

57
Q

What are the tests for developmental dysplasia of the hip?

A

Barlow and ortolani

US if these are positive

58
Q

What is the management of DDH?

A

Normally they spontaneously stabilise by age 3-6 weeks
Hips that remain unstable at 6 weeks require some treatment…

<4.5 months=long term splinting (Pavlik Harness)

6-8 months= closed reduction

> 18 months= open reductiom

59
Q

What is the most common cause of hip pain in children aged 4-10?

A

Transient synovitis

60
Q

What are the features of transient synovitis?

A

Acute onset hip (and/or knee’ pain and limp, usually comfortable at rest)
Fever in a minority of pts

Following a recent viral infection or autoimmune disease

61
Q

What is the management of transient synovitis?

A

All investigations will be normal

It is self limiting after a few weeks, treat with rest and simple analgesia

62
Q

What are the risk factors for septic arthritis?

A 
Pre existing joint disease
DM 
Immunosuppression
CKD
Joint prosthesis
IVDU
63
Q

What are the causes of septic arthritis?

A

Staph aureus= most common

Neisseria gonorrhoea (sexually active patients)

Salmonella= sickle cell

64
Q

What are the clinical features of septic arthritis?

A 
Hot swollen joint 
Reduced ROM
Erythema 
Fever 
Rigid joint and pt wont tolerate passive movement
65
Q

What is the criteria used for septic arhritis?

A

Kocher criteria

Fever >38.5
Non weight bearing
Raised ESR
Raised WCC

66
Q

What are the investigations done for septic arthritis?

A 
Joint aspiration for MC and S
Bloods- raised WCC, ESR, CRP 
Blood culture
X-ray (widening joint space) 
US will demonstrate fluid
67
Q

What is the management of Septic arhritis?

What are the complications?

A

Antibiotics; 6 week course of flucloxacillim

Osteoarthritis and osteomyelitis are the complications

68
Q

What is osteomyelitis and what are the risk factors?

A

Infection of the bone
In children it affects the metaphyses of long bones due to high vascular supply

In adults it affects the vertebra and feet (diabetics)

Risk factors= DM, sickle cell, IVDU, immunosuppression, alcohol

69
Q

What are the causes of osteomyelitis?

A 
Staph aureus (most common) 
Salmonella (sickle cell)
70
Q

Ahat is the pathophysiology of osteomyelitis?

A

Haematogenous spread
Direct inoculation from trauma or surgery
Contigous spread from nearby infection

71
Q

What investigations are done for osteomyelitis?

A

Bloods- raised ESR, CRP, WCC
Blood culture
MRI= imaging of choice (x ray changes arent apparent for 10-14 days)
Bone biopsy and culture are gold standard

72
Q

What is the management of osteomyelitis?

A

Antibiotics- 6 week course of flucloxacillin
Start IV and swap to PO once temperature and inflammatory markers settle (after 4 weeks)
Surgical drainage may be required

73
Q

What is perthes disease?

A

Normally affects boys aged 4-8 years

It is avascular necrosis of the femoral head

74
Q

What are the clinical features of perthes disease?

A

Hip pain that develips progressively over a few weeks, limp, stiffness and reduced ROM.

75
Q

What investigations are done for perthes disease?

A

X- ray

Technetium bibe scan or MRI if x-ray is normal and symptoms persist

76
Q

What is used to stage perthes disease?

A

Catterall

77
Q

What is the management of perthes disease?

A

Conservative management with rest, analgesia, PT
Keep the femoral head within the acetabulum using a cast or braces
Surgery may be required for older children
Most cases resolve with conservative management

78
Q

What is juvenile idiopathic arthritis?

A

An autoimmune inflammation in the joints lasting >6weeks in children <16

79
Q

What rashis associated sigh JIA?

A

Salmon pink rash

80
Q

What is the management of JIA?

A

PT/OF and regular exercise
NSAIDS (ibuprofen and naproxen)
Corticosteroids
- intra articular injections are often used
DMARDS used if corticosteroids dont work
Biologics are highly effective

81
Q

What is SUFE?
How do you diagnose?
How do you manage?

A

Displacement of the femoral head epiphysis postero inferiorly

Diagnosis is confirmed by AP and frog leg lageral

Management is internal fixation with a single cannulaged screw

82
Q

What is Immune thrombocytopenia?

A

Immune mediated reduction leading to thrombocytopenia

83
Q

What are the clinical features of ITP?

A

Acute

  • more common in children
  • petechiae, purpura, superficial bruising and mucosal bleeding (gums and nose)
  • presents 1-2 weeks following a viral infection (or vaccination)
84
Q

What is chronic ITP?

A

More common in women

Runs a relapsing- remitting course

85
Q

What will the investigations results of immune thrombocytopenic purpura be?

How do you treat it?

A

Isolated thrombocytopenia

Mild symptoms do not raire treatment

Persistent minor or major bleeding may require treatment with oral prednisolone, IV anti D and IVimmunoglobulins
Life threatening haemorrhage can be treated with platelet transfusions

86
Q

What are the clinical features of appendicitis?

A 
Abdo pain 
Nausea
Vomiting
Anorexia
Low grade fever
Ovsings
Pain is dull and poorly localised initially before localising to the right iliac fossa

It is aggregated by coughing, jumping, walking

87
Q

What are the IX for appendicitis?

A

FBC- raised WCC, ESR, CRP

Urinalysis yo exclude pregnancy/UTI

88
Q

What is pyloric stenosis?

What are the risk factors?

A

Hypertrohy of the pyloric muscle leading to gastric outlet obstruction

FHx, male, first born

Clinical features 
Projectile vomiting (non bilious) around 30 mins afer feeding

Babies are still hungry and continue to feed until they become dehydrated and lose interest

89
Q

What investigations are done for pyloric stenosis?

A

Test feed- may be able to see visible peristalsis and olive sized palpable mass in RUQ
Stomach aspiration via. NG tube may be required to allow palpation
US abdomen

Hypochloraemic metabolic alkolisis with hypokalaemia and hyponatraemia on ABG

90
Q

Management of pyloric stenosis?

A

Stop oral feeding, pass NG tube and aspirate every 4 hours
IV fluids
Blood gases and U+Es

Surgical management- Ramstedts pyloromyotomy

91
Q

What are the clinical features of cows milk allergy?

A

Presents in first 3 months of life in formula fed infants
It is either IgE mediated or non IgE mediated

Pruritus 
Erythemia 
Urticaria 
Angio oedema
Diarrhoea
Vomiting
Colicky pain
92
Q

What are the investigations done for cowsmilk allergy?

A

IgE mediated- blood test for total IgE and specific IgE for cows milk protein (RAST test)

Skin prick/ patch testing

Non IgE= clinical diagnosis

93
Q

What is the management of cows mik protein allergy?

A

Avoid cows mik
Growth monitoring
Hypoallergenic formula - extensively hydrolysed formula
Nutritional counselling

Do not recommend soya base formulas!

94
Q

What is the aetiology of constipation?

A 
Mostly idiopathic 
Dehydration 
Low fibre 
Drugs- opioids, antihistamines
Hypothyroidism 
Hirschsprungs disease 
Hypercalcaemia
95
Q

What are the red flag symptoms with constipation?

A

Symptoms from birth or first few weeks of life

Meconium passed after 48 hours- hirschsprungs

Ribbon stools- anal stenosis

Abdo distension w/ vomiting

FHx of hirschsprungs

Leg weakness or motor delay

Abnormal appearance of anus (position, patency, bruising, fissures)

Abnormal appearance of gluteal/ sacral region (spina bifida ovculta)

96
Q

Prior to treatment of constipation, children need to be assessed for faecal impaction, what would suggest faecal impaction?

A

Symptoms of severe constipation
Overflow soiling
Faecal mass palpable in the abdomen (DRE should only be carried out by a specialist)

97
Q

How is faecal impaction managed?

A

Movicol paediatric plain

Add a stimulating laxaruve if no disimpaction after 2 weeks

98
Q

What general measures can you suggest for constipation?

A

Adequate fluid and fibre intake
Adequate physicak activity
Behavioural interventions- bowek habit diary, scheduled toileting, reward system
Seek help from health visitor

99
Q

How should you manage constipation in infants?

A

Not yet weaned;
Breast fed- constipation is unusual and should be investigated

Bottle fed- extra water between feedsm gentle abdo massage, bicycle infants legs

Being weaned/ weaned…

Extra warwr, diluted frit juice and fruit
Consider adding lactulose

100
Q

What are the risk factors for gord?

A

Prematurity
Cerebral palsy
Hiatus hernia
Congenital diaphragmatic hernia

101
Q

What are the management options for gord?

A

General measures- 30 degrees head tilt when feeding
Dont overfeed, give small frequent feeds

Specific measures…
. Breast fed: mix an alginate (gavisvon) with water and use immediately after feeds
Formula fed- add thickener or alginate to formula
. Omeprazole or ranitidine If alginate unsucessful
. Surgery (nissen fundoplication) may be required

102
Q

What are the signs and symptoms of clinical dehydration in children?

A

Symptoms
Appears unwell
Altered responsiveness (irritable or lethargic)
Decreased urine output

Signs
Sunken fontanelles
Sunken eyes
Dry mucous membranes
Reduced skin turfor 
Tachycardia 
Tachypnoea
103
Q

What are the symptoms and signs of shock?

A

Symptoms
Decreased levek of consciousness
Pale/mottled skin
Cold extremities

Signs
Tachycardia
Tachypnoda
Weak peripheral pulses
Prolonged CRT 
Hypotension
104
Q

What is the pathophysiology of hirschsprungs disease and what is the median age?

A

Hischsprungs disease is where there is absence of gabglionic cells of the myenteric (auerbachs) and submucosal (meissners) plexuses

The median age is 2 days

105
Q

What are the risk factors for hisrchsprungs disease?

A

Male
Down syndrome
FHx

106
Q

What are the clinical features of Hirschsprungs disease?

A

Failure to pass meconium within the first 48 hours of birth, abdo distension, bilious vomiting

107
Q

What are the differentials for failure to pass meconium?

A 
Hirschsprungs 
Meconium ileus
Intestinal atresia 
Midgut malrotation 
Imperforate anus
Anal stenosis
Constipation
108
Q

What investigations are done for hirschsprungs?

A 
Plain abdominal xray 
Contrast enema (enemas should not be used if there is a perforation)

Rectal biopsy (GOLD standard)

109
Q

What is the management of hirschsprungs disease?

A

IV abx
NG tube
Bowel decompression
Surgical resection of the aganglioni bowel

110
Q

What is the most common cause of intestinal obstruction in children?

A

Intususseption

111
Q

When does intususseption occur?

A

3-12 months

112
Q

What are the clinical features of intususseption?

A

Paroxysmal abdo pain;
Infant will cry, draw their knees up, turn lale, vomit

Blood stained stool- redcurrant jelly

Sausage shaped mass- RUQ

113
Q

What are the Ix and management of intususseption?

A

USS will show target like mass/ donut sign

Also want to do abdo xray (obstruction)

Management is reduction by air insufflation/enema

114
Q

What is mesenteric adenitis?

A

Acute enlargement of the lymoh nodes within the mesentery
If often follows a recent viral infection

Child will get acute abdo pain, often vonfused with acute appendicitis

It is diagnosis of exclusion

115
Q

In what time frame should you operate when the child has an inguinal hernia?

A

Baby <6weeks, operate in 2 days

Baby <6 months, operate in 2 weeks

Baby <6 years, operate in 2 months

116
Q

What are the DDx for small bowel obstruction in children?

What about large bowel?

A 
Duodenal atrsia 
Jejunal/ileal atresia 
Meconium ileus 
Meconium plug syndrome 
Intussusception

Large bowel- hirschsprungs
Rectal atresia

117
Q

What are the investigatons and management of midgut malrotation?

A

Ix;

  • AXR (double bubble sign)
  • upper GI contrast series (corkscrew sign)

Non sufgical management- asymptomatic pts can be managed with observation and GI decompression

Surgically with a Ladds procedure

118
Q

What are the causes of UTI (organisms)?

A 
Staph aureus 
Escerichia coli
Klebsiella
Proteus (boys)
Pseudomonas
Strep faecalis
119
Q

What are the risk factors for UTI?

A 
<1 years old
Female
Poor hygiene
Previous UTI
Incomplete bladder emptying 
VUR 
Sexual abuse
120
Q

What are the clinical features of UTI?

A

Infants- poor feeding, vomiting, irritability, lethargy, fever, offensive urine, jaundice

Children- dysuria, frequency, urgency, fever, abdo pain, loin tenderness, lethargy, anorexia, haematuria

121
Q

When do you suspect acute pyelonephritis?

A

Temperate >38 and bacteriuria

Or temperature <38 with bacteriuria and loin tenderness

Finals (24 decks)

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