Peadiatrics

Question 1

Nasolacrimal duct obstruction

-cause of persistent watery eye in infant
-caused by impeforate membrane, usually at the end of the lactimal duct
-management - massage lacrimal gland , sympyoms resolve in 95% by 1y/o. unresolved cases - opthal referral for probing

Question 2

Perthes disease

i. age of onset
ii. features
iii. Diagnosis
vi. Complications
v. cause

Answer 2

i. 4-8y/o
ii. hip pain - developes progressively over a few weeks, lip, stiffness and reduced range of hip movement
iii. Hip XR - widening of joint space, decreased femoral head size/flattening
iv. OA, premature fusion of growth plates
v. avascular necrosis of femoral head - impaired blood supply > infarction

Question 3

Bronchiolitis

i. Epidemiology
ii. Basics
iii. Features
iv. immediate peads referrals
v.consider referral
vi. investigation
vii. Management

Answer 3

i. most common cause of LRTI om <1y/o; maternal IgG provides protection to newborns against RSV; higher incidence in winter

ii. RSV (most common), mycoplasma, adenovirus, bacteriaa, risk increasis with bronchopulmonary dysplasia (e.g. premature), congenital heart disease or cystic fibrosis

iii. coryzal, mild fever, dry cough, increasing SOB, wheezing, feeding difficulties due to SOB

iv. apneoa, respi distress, grunting, chest recession, RR>70, central cyanosis, spo2<92%

v. RR>60, difficulty breastfeeding, low oral intake, dehydration

vi. immunoflurescence of nasopharyngeal secretions may show RSV

vii. oxygen if sats <92%, NG feeding, suction