PAEDS 2 Flashcards
Manipulation technique for a pulled elbow:
Hold elbow, extend and pronate.
More successful and less painful than other option of flex and supinating.
When should you refer a greenstick fracture to ortho?
> 20 degrees of angulation
What defines a greenstick fracture?
UNILATERAL cortical breech (kids bones are ‘bendy’)
What defines a buckle fracture, and buckle fracture managment?
incomplete cortical disruption, with periosteal haematoma causing swelling
Often no surgical intervention, often splinting and immobilisation without a cast is all that is needed.
Classic triad of symptoms in intussusception, though the triad is only present in 20% of patients, so must have a high index of clinical suspicion.
Redcurrant jelly stool
Bloody stool
Intermittent abdominal pain
Most common cause / association of intussusception:
Meckel’s diverticulum
First line investigation for intussusception, and what would be visualised?
Ultrasound
Target sign
Doughnut sign
When is an air enema contraindicated in suspected intussusception?
Cannot do if delayed presentation
Risk or evidence of perforation, ischaemia, peritonitis.
At what ages should paediatric inguinal hernias be repaired a) urgently b) electively
Early months e.g. 2-3. Most chance of strangulation. Urgent repair.
> 1 year can be elective.
Discuss criteria for immediate CT head in children presenting after a head injury:
Dangerous mechanism of injury
Signs of basal skull fracture
GCS <14, or <15 in baby
Suspected NAI
3 or more vomits
LOC >5 mins witnessed
Drowsy
Amnesia >5 mins
Seizure no prev epilepsy
Open / depressed skull #
Tense fontanelle
An AXR is performed in a child with Trisomy 21, bilious vomiting and abdominal distension. It shows the ‘double bubble’ sign - what is the diagnosis?
Duodenal atresia
Give 2 other gastrointestinal abnormalities associated with duodenal atresia / Trisomy 21.
Tracheoesophageal fistula
Hirschsprung’s disease
Tests associated with predicting Down’s syndrome antenatally:
beta-hCG 1st trimester
PAPP-A in conjunction with maternal age
Nuchal translucency US
Important conditions screened for on the neonatal blood spot test (5-8 days old):
Cystic Fibrosis
Sickle-cell
PKU
Homocysteinuria
Congenital hypothyroidism
Most common congenital heart defect in children with Trisomy 21.
AVSD
Weight schedule for newborns if no concerns:
Monthly for 6 months
2 monthly 6-12 months
3 monthly until 2 years
2 common causes of delayed gross motor development:
Duchenne Muscular Dystrophy
Cerebral Palsy
Why may a child complain of bone pain in leukaemia?
Increased pressure inside the bone marrow from hyperplastic marrow.
Outline the investigations in suspected leukaemia in a child.
FBC; anaemia, thrombocytopenia, leukopenia
Blood film - blasts
CXR - mediastinal lymphadenopathy
Bone marrow trephine and aspiration
Symptoms of leukaemia, related to bone marrow failure:
Fatigue, breathlessness, pallor
Bleeding, bruising
Infection, fever
Poor prognostic indicators in ALL:
<1 years / >10 years
T-cell lineage
WCC >50 at presentation
Chromosomal abnormality e.g. Philadelphia 9:22
Refractory to induction therapy
Most common organism in paediatric endocarditis?
Strep viridans
If a patient with cystic fibrosis were to present in the neonatal period, what would the most common presenting feature be?
Meconium ileus
AXR of Hirschsprung’s disease would show:
Narrowing of part of bowel (aganglionic segment) with a clear transition zone to normal bowel segment.
When is the combined test for Trisomy 21 done?
11-13+6 weeks
Why would NIPT be offered during pregnancy?
If combined / quadruple screening returned a ‘higher chance’ result
Combined and quadruple test results for Trisomy 21:
hcg high
PAPP-A low
nuchal translucency thickened
AFP, unconj oestriol low
hcg and Inhibin A high
4 components of the quadruple test, which is offered to women who book in later and done at 15-20 weeks.
AFP
Unconjugated oestriol
HCG
Inhibin A
How do the results for Trisomy 21 and Edward’s/Patau’s syndrome differ in the combined test?
Similar, but hcg tends to be LOW not high
Describe formation of conj and unconj bilirubin and key differences between the 2:
Hb breakdown -> unconjugated bilirubin, not soluble -> liver conjugates it -> conj bilirubin is soluble
Unconjugated bilirubin can cross the BBB
Physiological mechanism of action of phototherapy in jaundice:
Breaks down bilirubin into water soluble isomer for excretion
Some causes of neonatal jaundice:
HDN
G6PD deficiency
Biliary atresia
Breast milk jaundice
Bruising from traumatic delivery
Hypothyroidism
Congenital spherocytosis
Which neurological reflex is ‘abnormal’ in a newborn and why?
Babinski - ‘upgoing’ is normal in neonates
Common conditions of extreme prematurity (5):
RDS
IVH
NEC
Retinopathy of the newborn (<32w)
Chronic lung disease
3 hour old baby with respiratory distress. 5 potential respiratory causes:
TTN
RDS
Pneumothorax
Congenital pneumonia
Pulmonary hypoplasia
Risk factors for EOS neonatal sepsis:
Pre-term
PROM
GBS maternal infection
Maternal infection during labour / chorioamnionitis
Complications / long term effect of spina bifida:
Walking difficulties
Neuropathic bladder
Faecal incontinence
Learning difficulties
Bulbar symptoms
Seizures
Scoliosis
Best test for diagnose possible underlying cause of obstruction in neonates?
Upper GI contrast study
5 aspects of the APGAR scoring system:
Activity
Pulse
Grimace
Appearance
Respiratory
5 complications of phototherapy treatment:
Dry skin / skin rash
Dehydration
Diarrhoea
Eye irritation from blue light
Disrupted breast feeding establishment
4 long term sequelae of kernicterus:
sensorineural deafness
dystonic / choreoathetoid CP
Learning difficulty
Seizure
?Pathophysiology of retinopathy of prematurity
Increased oxygenation e.g. in NICU, leading to proliferative retinopathy / neovascularisation
Meckel’s diverticulum is a congenital diverticulum of the small intestine. What is it a remnant of, what does it contain, and though it is normally asx, how might it present?
Remnant of omphalomesenteric / vitelline duct.
Contains ectopic ileal (or gastric or pancreatic) mucosa.
Abdominal pain similar to appendicitis, also rectal bleeding, can be massive.
Intestinal obstruction due to omphalomesenteric band, or volvulus or intussusception.
Type of scan used in Meckel’s?
99 technetium pertechnate, high affinitiy for gastric mucosa
2 types of congenital visceral malformations:
Gastroschisis
Omphalocele / exomphalos
What does gastroschisis describe? How should this baby be delivered?
Congenital defect within abdominal wall, abdominal contents out.
Can be delivered vaginally but should go to theatre within 4 hours of delivery.
What does exomphalos / omphalocele describe? How should this baby be delivered?
Bowel and other organs within an amniotic sac.
CS should be done.
Staged repair as often there is a lack of space and high intra-abdominal pressure.
