Paeds 8 Flashcards
What conditions are associated with undescended testes?
Prader- Willi Syndrome
Kallmann
What are the complications of PUV?
Renal failure
Dysfunctional bladder
Infertility
What are the causes of VUR and how are they investigated?
VUR refers to a defect which results in urine flowing back up the ureters and into the kidney.
Primary:
This is a defect at the trigone region where the anti-reflux mechanisms fail.
- abnormally situated ureteric orifice
- Larger than normal orifice
Secondary:
This is when there is not a specific issue with the trigone region but instead a defect elsewhere
- Posterior urethral valves
- Dysfunctional bladder
Investigations:
- MCUG
- DMSA scan
Management:
- correct defect.
- prophylactic antibiotics
- anti-cholingerics
Surgical for primary:
- STING procedure (bulks the opening of the ureter)
- Valve ablation if PUV
What are you’re main differentials in ITP?
Henoch-Scholien Purpura
Leukaemia
Meningitis
HUS
DIC
What the prognosis of minimal change disease?
1/3rd fully recover
1/3rd relapse
1/3rd continually relapse
How is rheumatic fever treated?
Aspirin
One off dose of IM benzylpenicillin
followed by:
Penicillin V
Steroids can be used for Sydenham’s chorea
Best rest for joint pain
What is the prognosis of Henoch Scholien Purpura?
1/3rd relapse
<5% have severe renal failure
What is management of ITP?
Watch and wait. Avoid NSAIDs and Aspirin
- increases bleeding
If severe:
- Immunoglobulins and steroids
Major bleeding:
- FFP and splenectomy
What is the investigations one should do into Henoch scholien to rule out more sinister cause?
FBC
- infection
Blood film
- blast cells
Coagulation
- bleeding disorder
- infection
How many children have a re-occurrence of Hencoh Scholien
30%
What is the steroid regime for minimal change disease? And what are other aspects of the management?
High dose for 8 weeks on a reducing regime
- Albumin infusion
- Prophylactic antibiotics
- diuretics +/- ACE inhibitors
Name the facial features of fragile x-syndrome and what gene is affected?
Long face
Large ears
Low set ears
Macrocephaly
FMR1
What tests do you want into leukaemia?
FBC
Blood film
LDH
Coagulation studies
Xrays:
- chest x-ray
- CT staging
Special tests:
- Bone marrow aspiration with aspiration
- Lumbar puncture
What are the poor prognostic factors for ALL?
<1 year, >10year
T cell differentiation
WCC >50
BCR ABL
What is prognosis of osteosarcoma?
75% at 5 years
30% if mets
What is treatment of rheumatic fever?
Penicillin V One of IM Benzyl-penicillin Aspirin \+/- Steroids for chorea
What are the complications of patent ductus arteriolas?
Reduce blood to extremities
- increased risk of NEC
- Hypotension
- Pulmonary congestion
- heart failure
What is a regular inhaler called and what can it be used with and what is another inhaler type which is purple?
Meter-dosed Inhaler
- can be used with spacer device
Diskus dry powder inhaler
- usually used >8 years old
When is the echocardiogram done in kawasaki disease?
Diagnosis, 14 days after and 6-8 weeks
What causes the mortality in congenital diaphragmatic hernias?
Pulmonary hypoplasia
What grades of salter-harris need discussed with ortho?
Grade III and IV
- risk of growth disturbance
How are you going to manage bronchiolitis?
Most cases can be managed in community with:
- paracetamol
- hydration
Admit if:
<94% sats
<50% feeds
Apnoea episodes
Management:
- get nasopharyngeal aspirates to confirm diagnosis to allow seclusion on wards
- Supportive oxygen if <94%
- Supportive feeds (try reducing amount and increase frequency first, then move to NG tube)
- nasal suctioning
**consider X-ray if you suspect hyperinflation or collapse
If more severe:
- Oxygen 15L mask
- IV fluids
- Inform PICU
*Ribavirin can be used for those with underlying conditions
What is the prognosis of bronchiolitis?
Symptoms usually peak on day 5.
A dry cough is usually left for several weeks
How long does a paediatric femoral fracture take to heal?
Age + 1 weeks
Most other fractures 2-3 weeks
Do you examine a child’s ears nose or throat with croup?
No.
What advice would you give parents for croup?
Usually worse at night
May worsen before it gets better
Worsening advice
5 year old with abdominal pain and vomiting, differentials:
Acute appendicitis Mesenteric Adenitis DKA UTI Male - testicular torsion
How does the pain of a hydatid compare to testicular torsion?
Slower onset
What are the two peaks of testicular torsion?
Neonates
Adolescents
What is the most common leadpoint for intussecption?
No.1 Peyer’s patches
No.2 Meckels
What are the risk factors for IBD? and list some investigations:
Family history Seronegative athropathies Smoking (Crohns) Appendicectomy HLAB27
Investigations:
Bloods:
- FBC
- CRP/ ESR
Orifices:
- faecal calprotectin
X-rays:
- CT abdomen
- MRI abdomen
Special tests:
- Endoscopy/ colonoscopy + biopsy
What treatment can be given during a tet spell in tetraology?
100% oxygen
Morphine (>3 months)
Beta blockers
Fluid
What are the features of Kawasaki disease?
High grade fever >5 days Conjunctiva injection Bright red cracked lips Strawberry tongue Cervical lymphadenopathy Red palms and soles of feet - later peels
What is the line used for SUFE?
Line of Klein
Outline management of an asthma attack in children?
Sit up right O2 oxygen - achieve 94-98% - Salbutamol - Ipratropium - Magnesium sulphate 3x back to back nebs - prednisolone or IV hydrocortisone
If no improvement after first nebuliser then:
- IV access (VBG needed)
- consider IV Magnesium
- contact PICU
What is the most common fracture of the elbow and what must be assessed and why?
Supracondylar fracture
- often associated with neurovascular damage
What are some of the treatment options for a lazy eye?
Eye patches
Drops to blurr the good eye
Eye exercises
Surgical intervention
What bone fractures would suggest NAI?
Metaphysis
Spiral fractures
- limb has been torted
Rib fractures
If the mother has chicken pox 5 days before birth or 2 days after what is the risk to the baby?
What is the risk of mother developing chicken pox during pregnancy? (first time exposure)
Outline the management of given VZV immunoglobulin, acyclovir during pregnancy:
Neonatal varicella
- 20% mortality
- VZV Immunoglobulins should be given
During pregnancy:
- fetal varicella syndrome (learning difficulties, microcephaly)
Exposure and not previous exposed (need to check immune status of mother first)
<20 weeks: Immunoglobulin immediately
>20 weeks: Delayed 7 days immunoglobulins
Confirmed chicken pox:
- Expert help
- Aciclovir within 24 hours of onset
In a child with chicken pox, how long are they infective for?
2 days before rash
until 5 days after rash
What is the management of measles and what is the management of measles if an un-immunised child comes into contact with measles?
Isolate
Supportive management
Vitamin A
Contact public health
Unimmunised:
- Give MMR vaccine. *works sooner than exposure
List some clinical signs of ALL
Pale Bone pain Lymphadenopathy CNS palsies Orchidomegaly
What scan is used to assess for neuroblastomas?
MIBG scan
List some late effects of cancer treatment in children:
Secondary malignancies
- Hodgkin’s from radiation
Cardiac
- heart failure (chemotherapy agents and radiotherapy)
Endocrine
- delayed growth and puberty
Hearing impairment
- chemotherapy
In a bone marrow aspiration what investigations are done?
Morphology
- looking for blast cells
Immunophenotyping
- T cell, B cell
Cytogenetic analysis
- looking into the chromosomes
In a short child what would reasonable investigations consist of?
FBC CRP/ ESR U&Es LFTs Bone profile IGF-1 Vitamin D
*wirst x-ray
- this will give us a rough age of the child. i.e. if x-ray suggests slightly below the age the actually are then its likely constitutional.
if its very far behind it may be Growth hormone deficiency
*in females karyotyping for Turners syndrome should be considered
What is the treatment for GF deficiency?
Growth hormone
- often given for Turner’s syndrome
What would you expect the bone age to be in precious puberty?
Greater than the chronological age
- there is increased sex hormones closing the growth plates
How does scabies present, what is the treatment and advice?
Delayed Type IV hypersensitivity reaction to mites which lay eggs in the skin.
Presentation:
- intense pruritus
- web spaces of fingers is worse
- extensor surfaces of joints
- lateral aspect of hands
- periumbilical area
- genitals
Treatment:
- Permethrin cream *left on for 12 hours
- whole family needs treated
- all cloths and bedding needs washed at high temp
What imaging is required in suspected septic arthritis? and what is the most accurate management of the patient?
X-ray of joint
Ultra sound
Management:
- referral to orthopaedic for surgical aspiration and washout
BEFORE starting broad spectrum IV antibiotics
Between the ages of 1-5 years old what are the most common organisms to cause septic arthritis?
Staph Aureus
H. Influenza
Name two risk factors for Leg-Perthes:
Low birth weight
Short stature
What tests would you want in a child presenting with an abdominal mass that you are suspicious of cancer?
Bloods:
- FBC
- U&Es
- LFTs
- Coagulation
Orifices: Urine dipstick (Wilms tumour can can cause haematuria)
Imaging:
US of abdomen
MRI of abdomen
CXR (early mets to lung)
What is the first line investigation for pyloric stenosis?
Test feed
- this is usually done before US
What is a simple screening method that can be done to assess for coarctation of the aorta?
Feeling for femoral pulses
and
Four limb BP
What immediate management can be done for deterioration of Coarctation of the aorta?
Following surgery for Coarctation of the aorta - what pathology may still exist?
Prostaglandin infusion
Hypertension
- can remain despite surgery
What can be fitted to allow children to control defecation via an ostomy? how does it work and list some conditions it is used for:
Antegrade colonic Enema (ACE)
- ostomy is made which allows saline to injected into the bowel to stimulate a bowel motion.
- gives control to the child
- spinda bifida
- Quadraplegia
What are the clinical features of achrondroplasia?
Normal trunk length Short limbs Short fingers Frontal bossing Lumbar lordosis
*associated with hydrocephalus
What are ribbon stools associated with?
Partially perforated anus
Coeliac disease in children:
Failure to thrive
Developmental delay
Short stature
- advised not to introduced wheat at 6 months
- remember to ask when this was introduced.
How does a UTI present in <3 months:
Fever
Vomiting
Lethargy
Irritability
What are the red flags for UTI in a child?
- Recurrent UTIs
- Family history of VUR
- Antenatal diagnosed renal abnormality
- Constipation
- Constant dribbling (dysfunctional voiding) *suggests structural abnormality
- Poor growth
- Hypertension
- Spinal/ neuro lesion
What is urine collected in?
Bottle with Boric Acid
What is being looked for in US for a UTI?
Horseshoe kidneys
Dysplastic
Cystic
What are the causes of nocturnal enuresis:
and what are three things you could do to help?
Very deep sleep
Slower physical development
Physical:
- constipation
- diabetes
- Obstructive sleep apnoea
Urinary tract:
- delayed bladder developed
- small bladder
- overactive bladder
- UTI
- enuresis alarm
- Desmopressin
- Oxybutynin
Is tetralogy duct dependent?
Yes.
What is the most important thing to ask in the history when a baby comes in collapsed?
Feeding
Reduction in feeds leading up is suggestive of underlying disease/ pathology
When does the baby hold their breath in breath holding episode?
During expiration
Which fractures are suggestive of NAI?
Spiral
Metaphysis fracture
Rib fractures
What are the major risk factors for sudden death?
Prone sleeping
Hyperthermia
Sleeping in same bed
Smoking within household
Prematurity
