Paeds Key Points 4

Question 1

Phimosis

Answer 1

<2 - should resolve spontaneously
>2 - if pt has recurrent UTIs –> circumcision/surgery
Avoid forcible retraction in young children

Question 2

Perthes disease

Answer 2

M>F
Progressive hip/knee pain, antalgic gait, decreased range of movement, shortening of leg
X-ray - widening of joint space
Mx
- <6 - observation + cast/brace to keep femoral head in acetabulum
- >6 - surgical repair

Question 3

Pertussis

Answer 3

Bordtella pertussis - incubation period is 10-14 days
Coughing bouts, inspiratory whoop, subconjunctival haemorrhages, marked lymphocytosis
Ix - nasal swba culture
Mx
- macrolide if cough started <21 days ago
- 2 days off school while taking antibiotics
- notify Public Health England

Question 4

Slipped upper femoral epiphysis

Answer 4

10-15 years, M>F
Hip, groin, knee, medial thigh pain
Due to obesity

Question 5

Pneumonia management

Answer 5

Amoxicillin –> macrolides
If mycoplasma/chlamydia - macrolides
If associated with influenza - augmentin

Question 6

Beckwith-Weidemann syndrome

Answer 6

Large for gestational age foetus, polyhydramnios
Foetal macrosomia + macroglossia + hypoglycaemia
Associated with exomphalos and WIlm’s tumour

Question 7

Chondromalacia

Answer 7

Teenage girls
Soft patellar cartilage
Anterior knee pain when walking up and down stairs + when rising from prolonged sitting
Mx - physio

Question 8

Osgood Schlatter disease

Answer 8

Sporty teens
Tibial apophysitis
Pain, tenderness, swelling over tibial tuberosity
Pain relieved by rest and worse by kneeling/activity

Question 9

Osteochondritis dissecans

Answer 9

Post-exercise pain

Intermittent swelling and locking

Question 10

Patellar subluxation

Answer 10

Medial knee pain

Knee may give way

Question 11

Patellar tendonitis

Answer 11

Athletic teenage boys
Chronic anterior knee pain that gets worse after a run
OE - tender below patella

Question 12

Achondroplasia

Answer 12

Autosomal dominant

Short limbs and fingers, trident hands

Question 13

Growing pains

Answer 13

Not present at the start of the day
No limp or limitation of movement, well child
Leg pain with no obvious cause
Intermittent pain, worse after a day of rigorous activity

Question 14

Hirschsprung’s disease

Answer 14

Delayed passage of meconium and abdominal distention
Ix - full thickness rectal biopsy
Mx - rectal washouts, then anorectal pull through procedure

Question 15

Intussusception

Answer 15

6-9 months
Telescoping of bowel proximal to/at level of ileocaecal valve
Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool
Mx - reduction with air insufflation

Question 16

Malrotation

Answer 16

Bile stained vomiting, high caecum at the midline
Ix - upper GI contrast study and USS
Mx -laparotomy

Question 17

Oesophageal atresia

Answer 17

Choking and cyanotic spells following aspiration

VACTERL associations

Question 18

Biliary atresia

Answer 18

Jaundice >14 days + conjugated hyperbilirubinaemia

Mx - urgent Kasai procedure

Question 19

Necrotising enterocolitis

Answer 19

Premature baby, abdominal distension and passage of bloody stools
X-ray - pneumatosis intestinalis and free air
Mx - total gut rest and TPN

Question 20

Mesenteric adenitis

Answer 20

Central abdominal pain and URTI

Mx - conservative mangement