Pedia Gastro/polumonary Dis. Flashcards
3 yo child , crying, red currant jelly stool, vomiting, dx?
Most common site ??
First step to do with this pt???
Initial test?
Best confirmatory?
Intussusception
Iliocolic mc site
First step to do is rehydrating the pt
Initial is US
Enema is confirmatory
Key words ( sausage shaped mass, Dance sign, coiled spring appearance , target sign in transverse view of US, pseudo-kidney sign in longitudinal view, ..etc)
What is dunphy sign?
What is pediatric appendicitis score? And what are the parameters that got 2 points in it??
What is the age group of children who got appendicitis??
A1: cough tenderness
A2: see the pic,
A3: more than 3 years -children become adult!
Note**
2 points in adult are leukocytosis , rebound tenderness
5 weeks old boy , non bilios vomiting , epigastric mass ,dx??
What drug is associated with this case?
Dx test??
What u will see in dx test?(sign?)
1st thing to do with this pt??
Electrolyte disturbance in this pt??
Definitive ttt??
Pyloric stenosis
Erythromycin
US( thickness >4 mm, length more than 14 mm)
-target sign
-Doughnut sign
First thing to do is fluid resuscitation and electrolytes correction
-hypo Na , kypo K, hypo CL, metabolic alkalosis
- surgery after correction of electrolytes ( pyloromytomy)>Ramsted procedure
Child ,hx of vomiting and diarrhea, ate from restaurant 8 hr ago, most likely cause??
Staph aureus
Baby 9m, came with failure to thrive (FTT) since 6 months, best initial, best dx test??
Endoscopy and duodenal biopsy is confirming test!
What food are ci in celiac?
How to diagnose celiac?
Clinical
+
Serology
+
biopsy
= no need to repeat any test after 9-6 m!!! والله العظيم سيلياك!!
But if one of the test is positive, other not, u can repeat after 6-9 months.
If pt improved dramatically after giving gluten free diet , this also confirms the diagnosis
Celiac with skin rash, most likely dx?
Dermatitis herpetiformis
Dermatitis herpetiformis, comes in which pt??? How to dx? What is the ttt??
In celiac pt
Gluten free diet in celiac decrease what risk??
Risk of developing intestinal lymphoma (ca)
Baby with acute vomiting,fever, bloody diarrhea, management?
Initially, if pt have signs of dehydration, rehydration goes first then give antibiotics for suspected pathogens, mainly shigella is suspected if no hx of antibiotics intake, (c. Defficle) , give IV ceftriaxone!
Child with amoebic liver abscess , ttt?
Oral metronidazole 7-10 days
Or tinidazole
Followed by diloxanide furoate!
If infection by ambiasis (entameba hystolytica) with GI symptoms with no abscess , give metronidazole followed by paromomycin
Surgery is CI , only if antibiotics failed
2 m boy , deep jaundice , pale stool, healthy , grow well, dx???
Billiary atresia (grow well!)
Note * in neonatal hepatitis and galactosemia»_space;(FTT) *
Ddx of neonatal jaundice ( mention 4)
Note* think of cholodochal cyst if there is a family hx*
Gall bladder ghost triad ?
What id the congenital heart dis that associated with allagile syndrome?
Mention the signs and symptoms of allagile syn??
How many types of caroli dis??
What is it caroli dis?
How to differentiate between caroli dis and caroli syndrome?
Caroli disease: dilation of intrahepatic bile ducts
Caroli syndrome : caroli disease and congenital hepatic fibrosis
What differentiate organic from functional pain??
Child with fever and icterus, recent hx of traveling, which type of hepatitis?
Hap A and E
Child with blood diarrhea , followed by convulsions, organism???
Shegella
- direct effect of shigella of cns (encephalopathy)»_space; Ekiri syndrome
Child, known case of GERD, uncontrolled symptoms, regurgitation/reflux, emesis, excessive chewing , growth failure, feeding refusal, oesophageal endoscopy showed multiple rings similar to trachea appearance , biopsy found high number of eosinophil, dx???
Other dis. Associated with this case???
Ttt???
Allergic oesophagitis or eosinophilic oesophagitis
-it’s associated with atopy (asthma, eczema..)
1st line ppi ( but 50% of children not responding 🥹)
2nd line topical steroid
Avoid allergen
Dilatation in case of ring stricture
3 yo hx of frequent blood in diaper , baby healthy and vital stable, dx??
Dx test? (Confirm)
Type of tissue present in this dx?
Mickel diverticulosis (MCC of painless bloody stool)
Nuclear scan (meckel scan or meckel scintigrapgy)
Gastric (MC!) or pancreatic or colonic
Child with recurrent attacks of bilious vomiting and bloody diarrhea, dx??
Ttt??
Mid rotation valvulos
C/p:
Drawing up the legs (severe pain causing that!)
Abdominal distension
Rapid HR
Rapid breathing
Blo. Stool
Malnutrition
Vomiting bile
Ttt: initial (see the pic) and Emergency surgery (ladd procedure مهمممم)
Key words of rectal bleeding : dx!?
Painful acute with fever?
Jelly stool?
Chest pain or heartburn??
Purpuric rash ?
Introduction of cow milk?
Recurrent with attacks of vomiting?
Painless rectal bleeding?
Family hx?
Down pt (trisomy 21) delayed pass of muconium to second days of like, PR > empty rectum , then gush of stool , dx? Best confirmatory test.???ttt?
Empty rectum (احفظي لا تفهمني)
Hirschsprung disease ,biopsy
Common in down
Initial test x ray or barium enema ( transtional zone)
Ttt: surgery > colostomy
Different between valvulos and hirshspring dis???
2 months baby hx of excessive crying, diarrhea, frequent vomiting, mother shifted mulk to soy milk, baby still crying, baby has facial eczema, most likely cause??
Cow milk allergy
Can be associated with IgE mediated ( eczema or anaphylaxis) or not (constipation,GERD, food intolerance)
Baby on breast feeding exclusively, when to give iron supplements??
4 m until baby take enough food containing iron!
Baby, bloody stool, dx??? If doctor told it’s preventable cause????
Anal fissure
Colic definition (hint: rule of 3)?
See pic
+ disappear after 3 months of age
(12 weeks)
Baby with vomiting after meals, normal growth, dx?? Ttt?? Confirming test?,
-dyskentic neck while crying in GERD, name of syndrome?? In pic?
GERD ( disappear usually around 18-24 months)
Other symptoms of GERD (severe):
Apnea, cyanosis , recurrent chest infection, dyskentic neck while crying 😢 ( sandifer syndrome )
Reassurance
PH Probe
Ppi in severe cases
Baby, diarrhea, weight loss, stool examination (trophoziote!!!!) ,dx?????
Risk factors? Give me 4!
Best initial test?
Best diagnostic??
Chronic giardiasis!
(Cause steatorrhea 🥲)
Best initial: 3 stool sample in different days!
Diagnostic: stool antigen or PCR
9 yo boy, deterioration in school performance, behavioural changes, dysarthria, jaundice , hepatomegaly ,dx?
Initial test?
Confirming test?
Ttt?
Type of inherence?
Wilson dis.
Best initial: low serum ceruloplasmin if not available, 24 hrs urine collection for copper
Confirming: liver biopsy or genetic
Ttt:? D penicillamine if not available, trinitite hydrochloride
Chromosome13 , autosomal recessive!
what is the best age to introduce egg for child to decrease chance of allergy???
Before 8 months!! This also will decrease the chance of getting DM type one and obesity!
What are the foods u should never give before one year of life???
Child, perianal itching , rice like coming out, organism?
How to dx?
Pin worm or enterobius vermicularis
Make sleep difficult ( itching mostly at night🤮)
Paddle test
Difference between Functional and hirschsprung dis???
Best ttt for functional is??
Laxative as well as diet and behavioural therapy.
Key words in diarrhea:
Watery green ?
Bloody diarrhea with mucos
Greasy bulky stool ?
Frothy diarrhea with diaper rash
Pale stool
Pellet like stool
Greasy»_space;قردة
Distinguish biliary atrasia from neonatal hepatitis is ????
Hepatobiliary scan! HIDA
What are the indications to remove an ingested foreign body by child???
Child, GI symptoms, +ve secretin test?
What is the diagnostic test for this dis?
Gastrinoma (abdominal pain/diarrhea)
Diagnostic test is : high serum gastrin
If gastrin normal secretin stimulation test.
1 month old, jaundice jaundice after milk , hepatomegaly, cataract , dx??
Which infection is associated with this dx???
How to diagnose??
What are the late presentation of this dis??
Galactosemia
(There are 3 types of it..:(
Associated with recurrent E coli infection
Blood test , previously was diagnosed by liver biopsy
See the pic for late presentation symptoms
8 yo, 2 month hx of abdominal pin, 2 hx of bloody stool, proctoscope showed numerous polyps, dx??
Familial polypoid
The hereditary polyposis syndromes include the adenomatous polyposis syndromes (familial adenomatous polyposis and Gardner syndrome, and Turcot syndrome) and the
hamartomatous polyposis syndromes (Peutz-Jeghers syndrome, juvenile polyposis, and Cowden’s disease).
One of the hereditary polyposis is :مهم
Baby delivered with respiratory distress, excessive secretion, NG tube was coiled , this baby will suffer from voice change after surgery, why???
GERD!
Other complications:
NG tube coiled , baby have oesophageal atresia what other anomalies u think it’s associated with it??
VACTERL association:
Note* cardio (TOF!!)
3 yo, barking cough, recurrent stridor ,, positive monophasic wheeze im auscultation,dx???
Tracheomalacia
Diagnostic test is bronchoscopy
Ttt:see pic
Note*
Tracheomalacia is less common and more dangerous than laryngeamalacia !
Laryngomalacia : characterised by (stridor worse with supine improved by prone or lateral position)+ omega shaped epiglottis, clinical diagnosis but confirmed by laryngoschope
1 yo child, close contact with TB, what is next???
Do PPD, chest x ray and start INH right away!
Baby, cerebral palsy , what type of respiratory failure might develop??
Hypercapnia (Type 2)
Any lung disease (except asthma and COPD )»_space;type 1 (hypoxia)
Any neurological dis, COPD and asthma»_space; it’s type 2
Child , bilateral nasal polyps, test might help??mcc of this condition ??
Sweat chloride test
Cystic fibrosis mcc bilateral nasal polyps
Cystic fibrosis, what is screening test and what is confirming test????
Screening: Sweat chloride test
CFTR is confirming test (genetic test)
Criteria of dx: see the pic
CF baby 4 yo got pneumonia, what is the mcc organism?
What are the symptoms of cf??
What is the initial presentation of CF in new born??
Chromosome abnormality in CF is??
Pneumonia in CF:
If less than 5 years> staph aureus
If more than 5 years> areej
Symptoms: see the pic
Initial presentation: meconium ileus
Chrom. 7
Child with pneumonia, what is the ttt and indication of admission?
Q2 If admission, what medication u will give?
Most pediatric pt»_space;Outpatient on DOC which is amoxicillin
Indications:
Q2: answer
Ceftrixone+ macrolide
If ICU
Ceftriaxone + macrolide + vancomycin+ antiviral
Recurrent Sinopolmunary infection+ dextroxardia ,dx??
Kartgener syndrome
7 yo child, eyelid erythema, thickening of skin over metacarpophalangeal joints + muscle weakness, dx??
Tell me a signs names u could see in this dis?
Best initial?
Other test can be done?
Best test??
Treatment
Juvenile dermatomyositis
Muscle weakness»_space; gower sign
V sign
Shawl sign (see the pic)
Best initial: CK serum
Others: antibodies (ANA,MSA, anti helcase , are +ve in 10-30% of cases), also MRI and EMG are good tests
Confirming test: Muscle biopsy!
Child, recent hx of URTI 3 days ago,present with hip pain, limited movement, afebrile , US shows Hip joint effusion,dx???cause ??ttt?
Toxic synovitis
Unknown cause!
Ttt: no need for ttt (no antibiotics) only supportive
Dx?? And ttt? Complications??
A systemic idiopathic juvenile arthritis
Ttt:
1st line agent: NSAID
2nd line: methotrexate
Note** folic acid and calcium leucovorin can help to decrease methotrexate toxicity!
Steroid can be given intra articular in pt with severe pain
3rd line
Biological agent (Anti- TNF)
Complications:??
See the pic
Child, interphalangeal joint nodule and subcutaneous nodule, next step in investigation?????
RF!
C! MC system involved in SLE !!!
SLE pt , u want to monitor therapy, what u will order??
Anti double strand +ESR
NEVER CRP!!!!!!!
4 y o , JIA (juvenile idiopathic arthritis) pt ,+ve ANA, when u will screen for anterior uveitis ??
Every 3 months!
