Paeds general Flashcards
Tetralogy of Fallot
- Presentation
- Auscultation findings
Presents 1-2 months of life.
Auscultation: ejection systolic murmur at the left sternal border secondary to pulmonary stenosis.
Transposition of the great arteries (TGA)
Loud S2
Cyanosis within first 24 hours of life
Common in infants of diabetic mothers
Henoch schonlein purpura
- small vessel vasculitis
- Triad of purpura, abdominal pain, arthritis (check urine dip for haematuria/proteinuria)
- Supportive Mx
DKA
- hyperglycaemia, acidosis and ketonaemia
- presents with drowsiness, abdominal pain, nausea
Name some dysmorphic features of Down syndrome
Upward slant of the eyes
Prominent epicanthic folds
Flat nasal bridge
Short neck
Features of Foetal alcohol syndrome
Small palpebral fissures Absent philtrum Thin upper lip Growth retardation Developmental delay
Febrile seizures
Associated with fever >38.5 C
Reassure
Manage fever
Treat source of infection
Stop fit (buccal midazolam, rectal diazepam)
Increased risk of epilepsy only if prolonged fit, family history of epilepsy, onset <1 year, > 1 febrile seizure during an illness
DDx. chronic diarrhoea
Functional (Toddler diarrhoea)
Infectious (Gastroenteritis) - oral rehydration + ondansetron
IBS
Coeliac
IBD
CF
Others e.g HIV
DDx. bloody diarrhoea
Infectious colitis - Infectious salmonella/campylobacter
Allergic colitis – CMPI
Inflammatory bowel disease (usually > 2yo)
Meckel’s diverticulum
HUS
DDx constipation
Functional - dietary change, coercive potty training, emotional/behavioural factors
Organic Hirshprungs disease Metabolic - Ca2+++ Hypothyroidism Neuro- developmental Anal stenosis Anal fissure
Ask about ? Delayed meconium passage or ribbon
Early bowel habit
Mx of constipation
Laxatives
In children over 1 year of age with faecal impaction, an oral preparation containing a macrogol (movicol is a common brand name) is used to clear faecal mass
Osmotic (e.g. lactulose /Movicol)
Stimulant (senna/picolax/docusate) - If disimpaction does not occur after 2 weeks, a stimulant laxative should be added.
Clear out
Impaction regime
Enema’s / suppositories
Lavage (Klean-prep / Movicol)
Achondroplasia
Disproportionate -Short limbs Autosomal dominant FGFR3 mutation Normal IQ Respiratory & CNS complications
Turners Syndrome
45 XO Short Stature Gonadal failure Webbing of neck Cubitus valgus Coarctation of aorta Horse shoe kidneys Lymphedema
Young child presenting with drowsiness, abdominal pain, nausea
DKA
Cautious fluid replacement Insulin infusion Frequent obs HDU if unwell Discuss with senior and diabetic team
Complications
- Hypokalaemia - Consider temporarily stopping the insulin infusion
- Cerebral oedema treat with mannitol or hypertonic sodium chloride
Enuresis
Day-time - delayed bladder maturity Increase drinks – usually ++! Regular voiding / reminding (Possible treatment Oxybutinin)
Nocturnal enuresis
Increase drinks but limit pre-bed
Lifting / alarms
(possible treatment Desmopressin)
Haemolytic uraemia syndrome (HUS)
Triad
- microangiopathic hemolytic anemia/
- thrombocytopenia
- acute kidney injury
Complication of E.coli
This should be considered in any child coming with diarrhoea and developing pallor and jaundice
Ix
- Stool specimens for culture
- A full FBC
- Blood film
- Renal function with serum electrolytes
Nephrotic syndrome - Triad of features
Proteinuria
Hypoalbuminaemia
Generalised oedema
Emily is eleven. She presents to her GP with two days of dark, Coca-cola coloured urine. She has had a recent sore throat but is otherwise well.
Check urine dip, BP
Post strep GN
Penicillin 10 days
Glomerulonephritis
Triad of:
Haematuria
Hypertension
Oedema
Acute renal failure
Pre-renal
Dehydration / sepsis
Post op hypoperfusion
Ischaemia (eg perinatal asphyxia)
Renal
Drug toxicity Haemolysis/ Myoglobinuria Glomerulonephritis Haemolytic Uraemic Syndrome Acute on background of chronic impairment Post-renal
Stones
Ventricular septal defect
- pan-systolic murmur
- failure to thrive
Intussusception
< 2years
Features of bowel obstruction, pale, irritable, draws legs up, short hx of colicky abdo pain, RUQ mass
Blood stained redcurrent jelly
Ix
- air contrast enema + abdo USS
- PR
- AXR
Mx
- fluids, NG tube, referral to surgeons
- reduction using air or barium enema
- bowel resection
- rectal air insufflation with fluoroscopy guidance
Complications of minimal change disease [3]
increased risk of thrombosis e.g. DVT
Infections
Hypercholesteremia
Neonatal resuscitation [9]
- Dry the baby
- Assess the tone, BR, HR
- If gasping or not breathing = give 5 rescue breaths
- Reassess
- If chest is not moving = consider 2-person airway control and repeat inflation breaths
- If chest is moving but HR is <60 bpm = ventilate for 30 seconds
- Reassess = if HR is <60 bpm = start chest compressions with ventilation breaths (3:1)
- Reassess every 30 seconds
- If HR remains <60 bpm = consider venous access and drugs (atropine)
Necrotizing enterocolitis
Vomiting, feeding intolerance, abdominal distension.
Watery stools with specks of blood present within the nappy.
Abdo X-ray: gas cysts in the bowel wall
Basic clotting screen
APTT, blood film, FBC, INR
Haemophilia A
Elevated APTT, normal INR, bleeding time, FBC and platelet count
- Haemarthrosis of the knee
Perthes’ disease
- avascular necrosis of the head of the femur
Complications of haemophilia A
- chronic arthropathy
- compartment syndrome
- haematuria
- Hepatitis B
