Pediatrics- try randomised Flashcards
It usually presents with bilious vomiting, abdominal distension, constipation
Hirschprung
and failure to pass meconium in the first 48 h
unborn has exomphalos management
C section at 37 weeks
5 c/ks of Rickets
Unsupplemented cows milk
Rickety rosaries
Kyphoscoloisis
craniotabes
Harrison sulcus
High ALP in children may indicate
Rickets
Early vs late shock
blood pressure
heart rate
respiration
extremities
urine output
Early
normal bp
tachycardia
tachypnoea
pale or mottled
reduced
Late
hypotension
bradycardia
acidotic (Kussmaul) (Lactic acidosis increases)
blue
absent
A 15 kg 3-year-old boy with a background of vomiting and passing loose stools for 5 days presents to the paediatric emergency department with increasing irritability and tiredness. He has not eaten for the past 2 days and has only been able to tolerate a minimal amount of fluid. His mother notices that he passes urine less often as well.
On examination, the boy appears to be lethargic and there is altered responsiveness. His heart rate is 160 beats per minute (95-140 /min), respiratory rate is 32 breaths per minute (25-30/min) and systolic blood pressure is 90 mmHg (80-100 mmHg). His temperature is normal.
There are no skin rashes. Capillary refill time is 4 seconds and his extremities are cold and pale. Skin turgor is reduced and the mucous membranes are dry.
how would you manage the patient based on your conclusion?
Use glucose-free crystalloids that contain sodium in the range 131–154 mmol/litre, with a bolus of 20 ml/kg over less than 10 minutes for children and young people, and 10–20 ml/kg over less than 10 minutes for term neonates.** An exception will be for children with severe diabetic ketoacidosis who are in shock, where an initial bolus of 10ml/kg of 0.9% sodium chloride is recommended and subsequent bolus to be administered if necessary after discussing with the specialist. This is to lower the risk of cerebral oedema in the patient.
A 9-day-old pre-term neonate stops tolerating his cow’s milk feeds given by the nurses in the special care baby unit. He vomited after the most recent feed and the nurse noticed bile in the vomit. Stools are normal consistency but the last stool contained fresh red blood. On examination he is well hydrated but his abdomen is grossly distended and an urgent abdominal x-ray is requested. X-ray shows distended loops of bowel with thickening of the bowel wall. What is the next best step in managementCommence broad spectrum antibiotics
Commence broad spectrum antibiotics
This scenario describes a case of necrotising enterocolitis. Given the history and examination along with the age and prematurity of the infant, bacterial necrotising enterocolitis is the most likely diagnosis.
X is given antenatally to prevent necrotising enterocolitis but is not useful in treatment.
Erythromycin
Low dose ICS
Budesonide
Whooping cough incubation
5-10 days
21 days maximum
21 days is usually considered the end of the condition
whooping cough
Salmon pink rash
JIA
JIA age and duration
younger than 16 and lasting for longer than 6 weeks
medication for scabies
permethrin
Episodic hypercyanotic spells that result in loss of consciousness
Tetralogy
Bottle fed infants are at increased risk of
necrotising enterocolitis
What bilirubin is elevated in biliary atresia
conjugated bilirubin
Cough of pertussis
Long inspiratory effort with whoop at the end of paroxysm
Cough of pertussis
Exclusion from school
Long inspiratory effort with whoop at the end of paroxysm
2 days after antibiotics/ post 21 days symptom onset
Necrotising enterocolitis
bilious vomitting, bloody stools, abdo distended.X ray distended bowel with thickening of the bowel wall
