Paeds 3

Question 1

What is the presentation of a malrotation/volvulus?

Answer 1

• bilious vomiting

- abdominal distension

Question 2

How do you manage malrotation/volvulus?

Answer 2

• contrast study for diagnosis

- urgent surgical referral

Question 3

How does hirschsprung’s/meconeum ileus/intestinal atresias ppresent?

Answer 3

-delayed passage of meconium
-abdo distension
-bilious vomiting
(surgical referral)

Question 4

How does NEC present?

Answer 4

• usually prem
• abdo distension
• bilious vomiting

Question 5

How do you treat NEC?

Answer 5

• ABx
• enteral rest - PTN
• surgical referral if severe

Question 6

How does Paediatric GORD present?

Answer 6

• vomiting associated with feeds
• faltering growth
• oesophagitis +/- strictures
• apnoea whilst feeding
• aspiratino, wheezing, hoarseness
• iron deficiency anaemia
• torticolis

Question 7

How do you treat paediatric GORD?

Answer 7

• reassurance that this is normal
• position whilst feeding
• smaller more frequent feeds
• thicker feeds
• if persists offer alginate therapy

Question 8

How does food intolerance present and how do you manage it?

Answer 8

• vomiting
• diarrhoea or constipation
• eczema, puritis, erythema, angioedema lips, face and eyes
• LRT symptoms - wheeze
• IgE mediated - URT sneezing, rhinorrhoea or coongestion

-elimination diet

Question 9

How does pyloric stenosis present?

Answer 9

• progressive projectile vomiting
• hypokalaemic
• hypocholoric
• METABOLIC ALKALOSIS

Question 10

How do you manage pyloric stenosis?

Answer 10

-fluid and electrolyte placement prior to corrective surgery

Question 11

How does intussusception present?

Answer 11

• 3 to 36 months of age
• colicky abdo pain
• bilious vomiting
• RECURRENT JELLY STOOLS

Question 12

How do you manage an intussusception?

Answer 12

-air or barium enema for reduction

Question 13

How does a strangulated hernia/adhesion obstruction present?

Answer 13

• bilious vomiting

- abdo pain

Question 14

How may DKA present?

Answer 14

• polydipsia
• polyuria
• hyperglycemia
• ketonuria
• metabolic acidosis
• HYPOKALAEMIA

Question 15

How does acute appendicitis present?

Answer 15

• anorexia
• central abdo pain migrating to the RIF
• vomiting
• pyrexia

Question 16

What are some complications of vomiting excessively?

Answer 16

• hypokalaemia
• alkalosis
• hyponatraemia
• nutritional losses
• Mechanical damage - mallory-weiss tear. tears of short gastric arteries
• dental erosions/caries

Question 17

Name 3 antiemetics.

Answer 17

• cyclizine
• promethazine
• prochlorperazine - medication NV
• metoclopramide
• droperidol
• ondanzatron - PONV

Question 18

What are the red flags associated with vomiting?

Answer 18

• meningism
• costovertebral tenderness
• abdo pain
• any evidence of raised ICP: bulging fontanelle, worse in morning

Question 19

How do you investigate GORD?

Answer 19

• pH test
• Barium swallow and meal
• endoscopy
• PPI test

Question 20

What are red flags for constipation?

Answer 20

• delayed passage of meconium
• fever, vomiting
• failure to thrive
• tight empty rectum with palpable abdo mass
• abnormal neuro exam

Question 21

What are the long term complications of constipation?

Answer 21

• acquired MEGACOLON
• anal fissures
• overflow incontinence
• behavioural problems

Question 22

How do you manage constipation conservatively?

Answer 22

• explanation of normal function of bowel
• diet/fluids and exercise
• behavioural advice
• toilet training advice
• simple reward schemes

Question 23

How would you medically manage constipation?

Answer 23

• softener: lactulose, liquid paraffin
• bulking agent: fybrogel
• movicol
• senna
• phosphate enema
• anal fissure: anaesthetic cream +/- vasodilator

Question 24

define diarrhoea.

Answer 24

-change in consistency of stools
and/or
-increased frequency of evacuations +/- fever or vomiting which lasts less than 7 days but not longer than 14

Question 25

What factors do you look at when assessing a child's hydration status?

Answer 25

``` -level of activity: ~irratibility/restlessness = mild - moderate ~abnormal sleepiness/lehtargy = severe -sunken eyes -want of water: ~eager to drink - mild/moderate ~drinking poorly or not at all =severe -Skin turgor: ~visible for less than 2 secs = mild/moderate ~visible for longer than 2 secs = severe ```

Question 26

When do you perform stool micrbiology?

Answer 26

- suspected sepsis - blood or mucus in stool - immunocompromised Consider: - recent travel abroad - greater than 7 days of diarrhoea - uncertain of diagnosis of GE

Question 27

WOOO IBD - What's the difference between chron's and UC?

Answer 27

C -mouth to anus UC - colon only C - Transmural inflammation UC - muscosal inflammation C - granuloma UC - no granuloma C - rectal sparing UC - no rectal sparing C - fissures, fistula, abscesses and strictures UC - above rare extras C- perianal disease UC - primary sclerosing cholangitis

Question 28

main difference between adult and paed's IBD is GROWTH. Discuss.

Answer 28

- poor growth - delayed puberty - reduced final adult height - persistent poor growth may be the only sign of disease activity

Question 29

What's the treatment for induction and remission in mild to moderate IBD?

Answer 29

Induction - aminosalicylates | remission - aminosalicylates

Question 30

What's the treatment for induction and remission in severe IBD?

Answer 30

Induction - corticosteroids | Remission - mercaptopurine (6 MP) or Azathioprine

Question 31

What's the fluid dose for a bolus?

Answer 31

20 ml/kg 0.9% NaCl

Question 32

What 3 instances do you not give 20 ml/kg 0.9%NaCl as a bolus? What dose instead?

Answer 32

- DKA - Trauma - Neonates -10 ml/kg 0.9 NaCli

Question 33

What is the usual causative agent of a UTI in paeds?

Answer 33

E Coli

Question 34

Following the identification of a UTI, what elseshould you do?

Answer 34

USS of kidney/ueter to see wagwan -DMSA/MCUG depending on age, severity and type of organism.

Question 35

What is the most common paediatric malignancy?

Answer 35

leukaemia | -ALL most common

Question 36

What are the Sx of ALL?

Answer 36

-anaemia, pallor, fatigue -infections -bruising, nose bleeds (bone marrow failure Sx)