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
Palivucimab - protect against, eligible people
prevent rsv in
1) premature
2) infants with heart/lung deformities
3) immunocompromised
Murmur during systole
coarctation of aorta
Phases of pertussis
incubation: 5-10 day/s 21 days max
catarrhal phase
paroxysmal: symptomatic phase
convalescent phase- gradual recovery
transient synovitis follows
respiratory/ gi infection
other symptoms of JIA
IVG
XYV
pyrexia
lymphadenopathy
uveitis
anorexia
ana positive
Rheumatoid factor negative
murmur with tetralogy of fallot
ejection systloc at left sternal edge
A 34-year-old woman delivers a baby girl at 39 weeks gestation. This is her second baby; both pregnancies have been uncomplicated. A few hours after delivery, she notices her baby’s skin has a slight yellow tinge.
What is the most likely cause of this change in skin colour?
Rhesus haemolytic disease is the correct answer. Jaundice in the first 24 hours after birth is always pathological. Pathological jaundice is due to physiological problems in the red blood cells or a cross-reaction with the maternal blood. Since this is the woman’s second pregnancy, she probably has anti-D IgG antibodies that have crossed the placenta and caused fetal haemolysis.
Other differentials are ABO hemolysis, G6PD and hereditary spherocytosis
One sided preference before age of 1: referral
immediate referral if risk factor for CP is present
No NSAIDs for which condition
CHiceknpox increased risk of necrotising fasciitis
Saddle nose, hutchinsons incisors
Maternal syphillis
Causes of deafness
rubella, syphilis, cmv, mumps
ct
bleeds and bones
mri for everything else
genetic anticipation- aside from early detection
seen with
increased severity
trinucleotide repeat disorders
maternal syphillis presentation
hepatosplenomegaly, lymphadenopathy, anemia, jaundic
saddle nose, hutchinson incisors, deafness, rhinitis
triad for rubella
cataracts, deafness, cardiac abnormalities
gastroenteritis ivg
consider stool sample for correct antibiotic
Turners
multiple melanocytic naevi, horshoe kidney
late systolic murmur
mid-late diastolic murmur
pansystolic murmur
mitral valve prolapse and aortic coarctation
mitral stenosis - rheumatic fever
mitral and tricuspid regurgitation and VSD
infant resp rate
30-60
structural conditions that are autosomal recessive and their presentations
freidrichs ataxia:
ataxia telangiectasia
metabolic conditions that are autosomal dominant
hyperlipidaemia type 2, hypokalaemic periodic paralysis
metabolic conditions that are x linked recessive
hyperlipidaemia type 2 and hypokalaemic periodic paralysis
neonatal sepsis risk factors
categories
responsible organisms
premature <37
low birth weight,
early onset: within 72 hours: vertical
late onset- 72hours-28 days: contacts
GBS, Ecoli
others include S. epidermis,
gram negative pseudomonas aeruginoso, klebsiella, enterobacter fungus;
p
cxr for transient tachypnoea would show
hyperinflation of the lungs and fluid in the horizontal fissure.
recurrent UTI investigate with
micturating urethrogram
IVG for IBS/ other food intolerances
Hydrogen breath test
Cows milk protein intolerance
h poor weight gain (50th to 10th centile), on examination he has an erythematous, blanching rash over his abdomen, colicky abdominal pain and vomiting after feeds. He has been breast feeding with top ups of ‘Aptamil’ formula. What is the most likely diagnosis?
7 months would suggest the new introduction of top up feeds which correlates with the symptoms
Charlie is older than the classical age of presentation for pyloric stenosis (2 to 8 weeks very rare above 6 months)
The presentation is unusual for eczema, infantile colic and reflux due to the multi-system involvement in the history making cows’ milk protein intolerance more likely
Fetal alcohol syndrome:
short palpebral fissures
variable cardiac abnormalities - pansystolic mumur
Rubella most at risk
apart from triad other possible features
first 16 weeks of pregnancy
jaundice, hepatosplenomegaly, microcephaly, reduced IQ
Foetal varicella syndrome
Skin scarring
Eye defects- small eyes, cataracts, chorioretinitis
Neurological defects- Reduced IQ, abnormal sphincter function, microcephaly
