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Year 4 Paeds > Peershare > Flashcards

Peershare Flashcards

1
Q

neonatal resus

A
  • warm baby under lamp
  • dry as quickly as possible (helps stimulate breathing)
  • calculate APGAR score
  • delayed umbilical cord clamping
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2
Q

paeds life support

A
  1. look, listen, feel
  2. shout for help
  3. open airway
  4. 5 rescue breaths
  5. check for circulation (infants = brachial/femoral pulse, children = femoral pulse)
  6. 15:2 chest compressions to rescue breaths
    * chest compressions 100-120/min
    * 1/3 of AP dimension of chest - infants = two thumb encircling technqiue
    * children - compress lower 1/2 sternum
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3
Q

APGAR

A

assessed at 1, 5 and 10 mins
* appearance (skin colour) 0 = blue, 1 = peripheries blue, 2 = pink
* pulse 0 = absent, 1 = <100bpm, 1 = >100bpm
* grimace (response to stimulation) 0 = no response 1 = little response/aggressive stimulation for cry, 2 = strong response/crying
* activity (tone 0 = absent/floppy, 1 = flexed arms/legs, 2 = active/flexes and rists extension
* respiratory effort 0 = absent, 1 = slow/irregular/gasping, 2 = strong, regular, crying

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4
Q

def: caput succedaneum v caphalohaematoma

A

caput - crosses suture lines, collecting on scalp outside periosteum
caused by traumatic/prolonged/instrumental delivery
ablle to cross suture lines
no treatment - resolves in few days

cephalohaematoma - bloo dbetween skull and periosteu,
does not cross suture lines
traumatic subperiostel haematoma
resolves in few months with no treatment
risk of anaemia/jaundice should be monitored until resolves

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5
Q

causes: hypoglycaemia neonates

A
  • preterm <37 weeks
  • IUGR
  • GDM
  • maternal diabetes
  • hypothermia
  • neonatal spesis
  • inborn errors metabolism
  • nesidioblastosis
  • Beckwith-Wiedemann syndrome
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6
Q

def: nesidioblastosis

A

nesidioblastosis and insulinoma are disorders of the endocrine pancreas causing endogenous hyperinsulinemic hypoglycemia

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7
Q

def: Beckwith-Weidemann syndrome

A

condition that affects many parts of the body
classified as an overgrowth syndrome
affected infants are larger than normal (macrosomia)
some may be taller than their peers during childhood

BWS has various signs and symptoms, including a large body size at birth and taller-than-average height during childhood, a large tongue, and hypoglycemia (low blood sugar). In some children with BWS, parts of the body, such as the ears, may grow abnormally large, leading to an asymmetric or uneven appearance

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8
Q

def: hypoglycaemia neonates

A

?<2.6mmol/L
common even in term babies - can be hypoglycaemic for first 24 hrs but no sequelae

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9
Q

presentation: hypoglycaemia neonates

A

autonomic: hitteriness/irritable/tachypnoea/pallor
neuroglycopenic: poor feeding/sucking, weak cry, drowsy, hypotonic, seizures
other fx: apnoea, hypothermia

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10
Q

rx: hypoglycaemia neonates

A

asymptomatic = wncourage feeding and monitor
symptomatic/v low = admit to NICU and 10% dextrose IV

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11
Q

causes: IUGR

A
  • smoking, alcohol, or illicit drug use
  • infection: cytomegalovirus, German measles (rubella), toxoplasmosis, or syphilis
  • some seizure treatment
  • lupus, anemia, or clotting problems
  • hypertension
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12
Q

problems: preterm birth

A
  • RoP
  • necrotising enterocolitis
  • RDS
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13
Q

pathophys: NEC

A

part of bowel = necrotic

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14
Q

presentation: NEC

A
  • intolerance to feeds
  • vomiting (green bile)
  • unwell
  • distended tender abdomen
  • absent bowel sounds
  • blood in stool
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15
Q

ix: NEC

A

bloods - FBC for WCC< CRP, blod gas = metabolic acidosis) and blood culture ?sepsis
AXR - dilated loops of bowel, bowel wall oedema (thickened walls), pneumatosis intestinalis (gas in bowel wall), pneumoperitoneum and gas in portal veins

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16
Q

rx: NEC

A
  • NBM
  • IV fluids
  • TPN
  • NG tube - drip and suck
  • Abx

surgical emergency - may require temporary stoma

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17
Q

complications: NEC

A
  • perforation
  • peritonitis
  • shock
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18
Q

pahtophys: RoP

A
  • retinopathy of prematurity
  • abnormal development of blood vessels in retina
  • normal development stimulated by hypoxia - triggered by supplemental O2
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19
Q

ix: RoP

A

screen premature babies

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20
Q

rx: RoP

A

stop new vessel growth
1st line = transpupillary laser photocoagulation to halt and reverse neovascularisation
cryotherapy ot intravitreal VEGF inhibitors
surgery if retinal detachment

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21
Q

complications: RoP

A

scarring
retinal detachment
blindness

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22
Q

pathophys: RDS

A

commonly occurs before 32 weeks when lungs start to produce lung surfactant
* inadequate surfactant
* high surface tension with alveoli
* atelectasis (lung collapse) since more difficult for alveoli and lungs to expand
* inadequate gas exchange
* hypoxia and hypercapnia causing respiratory distress

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23
Q

ix: RDS

A

CXR = ground glass appearance

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24
Q

rx: RDS

A

antenatal maternal steroids (dexamethasone) with ? premature labour

  • intubation and ventilation if severe
  • endotracheal surfactant via endotracheal tube
  • CPAP via nasal mask
  • supplementary O2 to maintain 91-95% sats
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25
Q

complciations: RDS

A

short term:
* pneumothorax
* infection
* apniea
* IVH
* pulmonary haemorrhage
* NEC
long term:
* chronic lung disease of prematurity
* RoP
* neurological/hearing/visual impairment

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26
Q

presentation: RDS

A
  • tachypnoea >60RR
  • increased wob - chest wall recession (sternal and subcostal indrawing) and nasal flaring
  • expiratory grunting in order to create positive airway pressure during expiration and maintain functional residual capacity
  • cyanosis if severe
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27
Q

drug: keep duct open

A

prostoglandin E (alprostadil)

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28
Q

drug: close duct

A

ibuprofen/indomethacin

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29
Q

acute asthma: management

A

33 92 CHEST
PEF <33% predicted
sats <92%
cyanosis, hypotension, exhaustion, silent chest, tachycardia SEVERE
moderate - >50% PEF, >92% sats, no clinica; fx of severe asthma
severe - 33-50% PEF, <92%, HR >125, RR >30, use of accessory muscles
life-threatening - <33%, <92% sats, CHEST, altered consiousness, poor respiratory effort

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30
Q

acute asthma: 2-5 y

A

moderate - >92% sats, no clinical features of severe
severe - <92% sats, HR >140, RR >40, use of accessory muscles
life-threatening - <92%, cyanosis, hypotension, exhaustion, silent chest, tachycardia, agitation, poor respiratory effort, altered consciousness

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31
Q

rx: acute mild-moderate asthma

A

give 1 puff every 30-60 seconds of B2 agonist (salbutamol) using spaced or <3y close fitting mask
max 10 puffs
if symptoms not controlled - go to hospital
steroids given in exacerbation for 3-5 days (prednisolone PO)

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32
Q

rx: severe-life-threateneing asthma

A

call senior + anaesthetics
OSHIT ME
oxygen (<94%)
salbutamol (B2B)
hydrocortison IV
ipatropium bromide (B2B)
theophyline (aminophyline) IV
magnesium sulfate IV
escalate

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33
Q

rx: asthma

A

SABA - salbutamol
add ICS - beclomethasone
then LABA or LTRA - salmeterol or monetleukast and SABA

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34
Q

ddx: stridor

A

larygnomalacia
bronchiolitis
croup
acute epiglottitis
inhaled foreign body

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35
Q

cause: bronchiolitis

A

RSV

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36
Q

presentation: bronchiolitis

A

usually <1yr (most common <6months) but can occur up to 2 years
coryxal symptoms - runny nose, sneezing, mucous in throat, watery eyes
signs of respiratory disress
dysnoea
tachypnoea
poor feeding
<39 fever
apnoeas
wheeze and crackles with harsh breath sounds on auscultatiomn

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37
Q

signs: respiratory distress

A

tachypniea
accessory muscle (sternocleidomastoids, abdominal and intercostal muscles)
intercostal and subcostal recessions
head bobbing
nasal flaring
tracheal tug
cyanosis

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38
Q

abnormal airway noises

A

wheezing (usually expiratory)
grunting (ehaling with glottis sclosed increases positive end-expiratory pressure)
stridor (high pitched inspiratory noise)

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39
Q

typical course: bronchiolitis

A

starts as URTI with coryzal symptoms
can get better spontaneously, those who don’t tend to develop chest symptoms following coryzal symptoms
symptoms usually worse day 3/4 and last 7-10 days
full recovery within 2-3 weeks
more likely to get viral induced wheeze in childhood

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40
Q

when to admit: bronchiolitis

A
  • under 3 months
  • pre-existing conditions like prematurity, Down’s or CF
  • <50% intake
  • clinical dehydration
  • RR>70
  • O2 <92%
  • moderate to severe respiratory distress
  • apnoeas
  • parents concerned unable to manage at home
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41
Q

rx: bronchiolitis

A

ensure adequate intake (can be oral/NG or IV fluids)
saline nasal drops and nasal suctioning
supplementary oxygen
ventilatory support if needed

little evidence for neb saline, bronchodilators, steroids or antibiotics

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42
Q

ventilatory support

A

high-flow humidified oxygen (adds PEEP to maintain airway at end of expiration
CCPAP (higher and more controlled pressures than high flow)
intubation and ventilation

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43
Q

rx: palovozumab

A

monoclonal antibody targeting RSV given monthly injection as prevention against bronchiolitis caused by RSV
given to high risk babies such as ex-premature babies adn those with congenital heart disease

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44
Q

viral induced wheeze v asthma

A

VIW: presenting before 3 years old
no atopic hx
occurs only during viral infection

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45
Q

diagnosis: asthma

A

apirometry with reversivke testing (over 5y)
direct bronchial challenge test with histamine or methacholine
FeNO - fraction exhaled nitric oxide
peak flow variability (keep diary for 2-4 weeks)

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46
Q

cause: croup

A

parainfluenza virus

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47
Q

presentation: croup

A

6m - 2y
* increased WOB
* barking cough
* hoarse voice
* stridor
* low grade fever

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48
Q

rx: croup

A

PO dexamethasone 150microg/kg
can be repeated after 12 hours
severe stepwise approach:
* oral dexamethasone
* oxygen
* nebulised budesonide
* nebulised adrenaline
* intubation and ventilation

mild = withut stridor or significant indrawing = oral dex
moderate = stridor and chest wall indrawing but NO agitation = neb budesonide or high dose oral dex
severe = stridor and indrawing and agitation/lethargy = neb adrenaline and ?PICU

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49
Q

cause: acute epiglottitis

A

HiB

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50
Q

presentation: epiglotittis

A

LIFE THREATENING EMERGENCY
* rapid onset
* unwell child
* sore throat
* stridor
* drooling
* tripod position
* high fever
* difficulty or painful swallowing
* muffled voice
* scared quiet child
* septic unwell appearance

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51
Q

ix: epiglotittis

A

SHOULD NOT BE PERFORME WHEN ACUTELY UNWELL
lateral XR should thumbprint sign (soft tissue shadow that looks like a thumb pressed into trachea)

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52
Q

presentation: inhaled foreign body

A
  • coughing
  • choking
  • vomiting
  • stridor
  • previously well
  • rapid onset
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53
Q

presentation: pneumonia

A
  • cough (typically productive)
  • high fever (>38.5)
  • tachypnoea
  • increased WOB
  • lethargy
  • delirium (acute confiusion)
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54
Q

chest signs: pneumonia

A

bronchial breath sounds
focal coarse crachles
dullness to percussion

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55
Q

causes: pneumonia

A

bacterial - strep pneumonia (most common), group A strep and GBS if pre-vaccinated

viral - RSV most common or parainfluenza

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56
Q

ix: pneumonia

A

consolidation on CXR
sputum cultures, viral PCR and blood cultures if ?sepsis

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57
Q

rx: pneumonia

A

amoxicillin 125 (up to 1)
250mg up to 4 and 500mg up to 17, 3/day for 5 days
can add clarithromycin/erythromycin for atypical covre

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58
Q

cause: tonsilitis

A

group A strep (strep pneumoniae) = MOST COMMON
haemophilus influenzae
moraxella
staph aureus

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59
Q

presentation: tonsilitis

A

fever
sore throat
painful swallowing
peak 5-10 and 15-20 y
poor oral intake, headache, vomiting, abodominal pain non-specific in younger children

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60
Q

examination: tonsilitis

A

red, inflamed tonsils
+/- exudate
always eaxmine tympanic membranes and cervical lymph nodes

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61
Q

scoring: tonsilitis

A

feverPAIN score
score 1 point for each (maximum score of 5)
Fever (during previous 24 hours).
Purulence (pharyngeal/tonsillar exudate)
Attend rapidly (within 3 days after onset of symptoms)
Severely Inflamed tonsils
No cough or coryza

CENTOR
each scores 1 point, max 4
1. fever >38
2. tonsilar exudates
3. absense of cough
4. tender anterior cervical lymph nodes

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62
Q

rx: tonsilitis

A

if CENTOR 3+ or feverPAIN 4+ ?antibiotics or if immunocompromised or other co-morbidity e.g hx rheumatic fever

penicillin V for 10 days 1st line
clarithromycin in pen allergic

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63
Q

complications: tonsillitis

A

chronic tonsilitis
peritonsilar abscess = quinsy
scarlet fever
otitis media
rheumatic fever
post-streptococcal glomeruloneohritis
post-streptococcal reactive arthritis

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64
Q

additional symtpoms to tonsilitis: quinsy

A

trismus - unable to open mouth
voice changes “hot potato voice” - thick, muffled voice
swelling and erythema beside tonsils

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65
Q

cause: quinsy

A

group A strep
HiB or staph aureus

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66
Q

rx: quinsy

A

incision and drainage
?dexamethasone

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67
Q

cause: scarlet fever

A

group A strep (strep pyogenes) produces exotoxin

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68
Q

presentation: scarlet fever

A
  • red-pink, blotch, macular rash
  • rough sandpaper
  • starts on trunk and spreads outwards
  • red, flushed cheeks
  • fever
  • lethargy
  • flushed face
  • sore throat
  • strawberry tongue
  • cervical lymphadenopathy
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69
Q

rx: scarlet fever

A

notifiable disease - tell public health
pen V for 10 days
kept off school until 24 hours after starting abx

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70
Q

complications: scarlet fever

A

post-strep glomerulonephritis
acute rheumatic fever

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71
Q

cause: otitis media

A

strep pneumoniae most common

can be haemophilus influenzae
moraxella catarrhalis
staph aureus

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72
Q

presentation: otitis media

A

ear pain
reduced hearing (can be with effusion causing glue ear)
general URTI symptoms - fever, cough, coryzal symptoms, sore throat and feeling gnereally unwell
can cause balance issues

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73
Q

examination: otitis media

A

normally tympanic membrane = peraly grey, translucent and slightly shiny
otitis media = red, bulging, inflamed
may have discharge if perforated

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74
Q

rx: otitis media

A

refer and admit if <3m with temp >38 or 3-6m and temp >39
most resolve without abx
mainly resolve within 3 days
give analgesia

can give immediate abx in aptients with significant co-morbidities, are systemically unwell or immunocompromised
children <2y with bilateral otitis media or with otorrhoea (discharge)

delayed perscription - can be collected after 3 days if symtpoms persist/worsen

first line - amoxicillin for 5 days or clarithromycin in pen allergic

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75
Q

complications: otitis media

A

otitis media with effusion
perforated eardrum
mastoiditis
asbcess
hearing loss
recurrent infx

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76
Q

cause: whooping cough

A

bordetella pertusis(gram -ve)

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77
Q

presentation: whooping cough

A

starts with mild coryzal symptoms
low grade fever
mild cough
more severe coughing fits after 1+ weeks
sudden recurring attacks of coughing with cough free periods between
paroxysmal cough - coughing fit until patient completely out of breath then large, loud inspiratory whoop when coughing ends
may have apnoeas
may cough so hard - faint/vomit/pneumothorax

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78
Q

diagnosis: whooping cough

A

nasal PCR testing or bacterial culture
if cough been 2+ weeks present - aanti-pertussis IgG can be tested in 5-16y

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79
Q

rx: whooping cough

A

notifiable disease
supportive care
macrolide (azithro, calrihro, erythromycin) may be beneficial in first 21 days or in vulnerable pts
co-trimoxazole alternative

close contacts given prophylactic abx if vulnerable (pregnancy, unvaccinated infants, healthcare workers in contact with those people)

symptoms typically resolve within 8 weeks

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80
Q

complication: whooping cough

A

bronchiectasis

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81
Q

inheritance: CF

A

autosomal recessive

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82
Q

chromosome affected: CF

A

chromosome 7 delta-F508
codes for cellular chloride chnnels

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83
Q

consequences: CF

A
  • thick pancreatic and biliary scretions - blocks ducts (lacking digestive enzymes such as pancreatic lipase in digestive tract)
  • low volume thick airway secretions (bacterial colonisation) and susceptibolity to airway infections
  • congeniuital bilateral absence of vas dferens in mals (male infertility)
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4
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84
Q

diagnosis: CF

A

screened in heel prick test
gold standard test = sweat test
genetic testing for CFTR gene during pregnancy by amnicemtesis or CVS

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85
Q

pathognomonic sign: CF

A

meconium ileus
in around 20% of babies with CF, meconium thick and sticky causing it to obstruct the bowel causing meconium ileus
meconium not passed in 24hrs, abdominal distension and vomiting

86
Q

symptoms: CF

A
  • chronic cough
  • thick sputum production
  • recurrent respiratory tract infection
  • loose greasy stools (steatorrhoea) due to lack of fat digesting lipase enzymes
  • abdominal pain and bloating
  • child tastes particularly salty when they kiss them (concentrated salt in sweat)
  • failure to thrive
87
Q

signs: CF

A
  • failure to thrive on growth charts
  • nasal polyps
  • finger clubbing
  • crackles and wheeze
  • abdominal distension
88
Q

common colonisers: CF

A
  • staph aureus
  • psudomonas aeruginosa
89
Q

prophylaxis: CF

A

flucloxacillin (staph aureus)

90
Q

sweat test: CF

A

pilocarpine applied to skin on patch and electrodes placed on skin
causes skin to sweat and sweat absorbed with lab issued gauze and sent to lab to test for chloride concentration
>60mmol/l = diagnostic

91
Q

pseudomonas rx: CF

A

nebulised tobramycin
ciprofloxacin

92
Q

pseudomonas rx: CF

A

nebulised tobramycin
ciprofloxacin

93
Q

rx: CF

A
  • chest physiotherapy for secretions
  • excercise imporves respiratory fnx and helps clear secretions
  • high calorie diet due to malabsorption, high resp effort, coughing etc
  • CREON tablets for pancreatic insufficiency
  • prophylactic flucloxacilin
  • treat chest infections when they occue
  • bronchodilators
  • vaccinations
94
Q

monitoring: CF

A

every 6 months
* aputum cultures
* diabetes
* osteoporosis
* vit D deficiency
* liver failure

95
Q

life and QoL: CF

A

improving life expectancy - meadian 47 years

96
Q

surgical causaes: abd pain

A
  • intussusception - colicky, non-specific pain REDCURRANT JELLY STOOL
  • appendicitis - central abd pain spreading to R iliac fossa
  • bowel obstruction - absolute constipation, vomiting, pain and distension
  • testicular torsion - sudden onset, unilateral testicular pain N+V
97
Q

red flags: abd pain

A
  • persistent/bilious vomiting
  • severe chronic diarrhoea
  • fever
  • rectal bleeding
  • weight loss/failure to thrive/faltering growth
  • dysphagia (difficulty swallowing)
  • nighttime pain
  • abd tenderness
98
Q

ix: red flag abd pain

A
  • FBC - anaemia = IBD or coeliac disease
  • raised inflammatory markers (ESR or CRP) = IBD
  • raised anti-TTG or anti-EMA antibodies = coeliac
  • raised faecal alprotectin = IBD
  • positive urine dipstick = UTI
99
Q

content of vomit: abd pain

A

food/milk = GORD or pyloric stenosis
bilious = malrotation or intussusception or Hirschprung’s/meconium ileus if badly obstructed

100
Q

aetiology: GORD

A
  • contents of stomach reflux through lower oesophageal sphincter into oesophagus/throat/mouth
  • in babies immaturity of LOS allow contents to reflux more easilt - normal in infants and usually improves within 1 year for 90% patients
101
Q

presentation: problematic GORD

A

usually <8wks
* chronic cough
* hoarse cry
* distress/crying or unsettled after feeding
* reluctance to feed
* pneumonia
* poor weight gain

102
Q

red flags: vomiting

A
  • not keeping down any feed
  • projectile/forceful vomiting
  • bile stained
  • haematemesis/melaena
  • abdominal distension
  • reduced consciousness, bulging fontanelle or neurological signs - meningitis or raised ICP
  • blood in stools
  • respiratory symptoms
  • signs of infection
  • rash, angioedema
  • apnoeas
103
Q

rx: GORD

A

explanation, reassurance and practical adive in simple cases:
* small, frequent feeds
* burping regularly to help milk settle
* not over-feeding
* keep baby upright after feeding

more problematic:
* gaviscon mixed with feeds
* thickened milk (carobel)
* ranitidine (H2 receptor blocker)
* anti-reflux formulas
* omeprazole where ranitidine is inadequate PPI if feeding diffulties/distressed/faltering growth

104
Q

def: sandifer’s syndrome

A

rare condition causing brief episodes of abnormal movements assoc. with GORD
infants neurologically normal
key features:
1. torticollis - forceful contraction of neck muscles causing twisting of neck
2. dystonia - abnormal mscle contractions causing twisting movements, arching of back or unusual postures

105
Q

def: pyloric stenosis

A

hypertrophy of the pylorus (ring of smooth muscle between stomach and duodenum)
after feeding = increase peristalsis to push food to duodenm and eventually becomes so powerful causes food to project up oesophagus and projectile vomit

106
Q

features: pyloric stenosis

A

presents in first few weeks of like (4-6weeks)
* thin
* pale
* hungry
* failing to thrive

olive mass on examination
projectile, non-bile stained vomit

blood gas shows hypochloric metabolic alkalosis since baby vomiting hydrochloric acid from stomach

107
Q

ix and rx: pyloric stenosis

A

abd USS diagnosis or test feed
laparoscopic pylotoyomy (Ramstedt’s operation - incision made in pylorus)
excellent prognosis

108
Q

symptoms: mesenteric adenitis

A

URTI preceeds sore tummy

109
Q

rx: mesenteric adenitis

A

conservative

110
Q

def: coeliac disease

A
  • autoimmune condition where exposure to gluten causes immune reaction creating inflammation in small intestine
  • usually develops early childhood but can start at any stage
  • auatoantibodies created in response to gluten targetting epithelial cells of intestine - anti-TTG (transglutaminase) and anti-EMA (endomysial)
  • inflammation affects small bowel mainly jejunum and causes atrophy of intestinal villi causing malabsorption
111
Q

presentation: coeliac

A
  • failure to thrive
  • diarrhoea
  • fatigue
  • weight loss
  • mouth ulcers
  • anaemia (secondary to iron
112
Q

presentation: coeliac

A
  • failure to thrive
  • wasting of buttocks and distended abdomen
  • diarrhoea
  • fatigue
  • weight loss
  • mouth ulcers
  • anaemia (secondary to ironnand B12 deficiency)
113
Q

association: coeliac disease

A

T1DM - any new T1DM should be tested for coeliac disease, even if unsymptomatic

114
Q

auto-antibodies: coeliac disease

A

anti-TTG - tissue transglutaminase IgA
EMA - endomysial IgA

115
Q

diagnosis: coeliac disease

A

patient remains on gluten diet
check total IgA to exclude IgA deficiency
* raised anti-TTG ab
* raised anti-EMA (diagnosis if cymptomatic and raised anti-TTG and this)

endoscopy and intestinal biopsy show
* crypt hypertrophy
* villous atrophy (flat duodenal biopsy)

1 = symptomatic + markedly raised anti-TTG + raised anti-EMA
2 = asymptomatic + raised anti-TTG + duodenal biopsy

116
Q

rx: coeliac disease

A

lifelong gluten-free diet

117
Q

associations: coeliac disease

A
  • T1DM
  • thyroid disease
  • primary biliary cirrhoses
  • Down’s syndrome
  • autoimmune hepatitis
118
Q

complications: untreated coeliac

A
  • vitamin deficiency
  • anaemia
  • osteoporosis
  • ulcerative jejunitis
  • non-hodgkins lymphoma
119
Q

def: intussusception

A
  • bowel invaginates/telescopes into itself
  • thickens size of bowel and narrows lumen
  • causes palpable mass in abdomen and obstruction
  • often 3 months to 2 years
120
Q

presentation: intussusception

A
  • often a preceeding viral infection
  • severe, colicky abdominal pain
  • pale, lethargic and unwell child
  • redcurrant jelly stool
  • RUQ sausage shaped mass on palpation
  • vomiting
  • intestinal obstruction
121
Q

ix: intussusception

A

target/doughnut sign on USS

122
Q

rx: intussusception

A
  • air enema/rectal air insufflation
  • surgery required if unsuccessful or if peritonitis - bowel becomes gangrenous or perfed bowel
123
Q

complications: intussusception

A
  • obstruction
  • gangrenous bowel
  • perforation
  • death
124
Q

def: cow’s milk allergy

A
  • hypersenstivity to protein in cow’s milk
  • affecting infants and children under 3
  • IgE mediated (type I hypersensitivity - happens rapidly)
  • can alsobe non-IgE mediated (happening over time)
  • DIFFERENT TO LACTOSE INTOLERANCE (sugar not protein)
125
Q

presentation: cow’s milk allergy

A
  • usually <1 when weaned from breast milk to formula or foods containing milk or breastfed babies with mums consuming milk products

GI:
* bloating and wind
* abdominal pain
* vomiting
* diarrhoea (mucous)
* reluctant to feed/feeds little and then is sick/unsettled after feed

allergic general symptoms:
* urticarial rash
* angio-odemea
* cough/wheeze/sneezing/watery eyes

126
Q

rx: cow’s milk protein allergy

A
  • skin prick testing can support if IgE mediates
  • trial avoiding cow’s milk
  • Regular monitoring of growth and nutritional status (including faltering growth or excessive weight gain).
  • Advice on a cow’s milk-free diet including hypoallergenic infant formulas and suitable substitute foods if complementary feeding (weaning).
  • Advice on performing a cow’s milk elimination trial and home reintroduction, and follow-up.
  • If there is a clear improvement in symptoms, arrange a home reintroduction of cow’s milk into the mother’s or infant’s diet to confirm the diagnosis of non-IgE-mediated cow’s milk allergy.
  • hydrolysed formulas (neocate)
  • Trial of milk ladder every 6 months from age 1
  • should grow out of it by 2-3 if intolerant
127
Q

def: Meckel’s diverticulum

A
  • most common cause of paediatric massive PR bleed
  • ileal remnant of suct
  • technetium scan = increased uptake by ectopic gastric mucosa and ?laparoscopic examination for diagnosis
  • tx: surgery
128
Q

def: malrotation

A
  • comgenital abnormality
  • small intestine lies mainly on RHS abdomen with caecum in RUQ
  • presents in first 3 days of life with intestinal obstruction
  • Ladd bands obstructing duodenum/volvulus
129
Q

presentation: malrotation

A
  • bilious vomiting
  • abdominal pain
  • tenderness/peritonitic/ischaemic bowel
130
Q

ix and tx: malrotation

A
  • urgent GI contrast studdy and USS
  • surgical correction (Ladd’s procedure)
131
Q

def: Hirschprung’s disease

A
  • congenital condition where nerve cells of myenteric plexus absent in distal bowel and rectum (Auerbach’s plexus)
  • stimulates peristalsis of large bowel
  • absent parasympathetic ganglion cells in end section of colon
  • aganglionic section constricts and causes obstruction
132
Q

associations: Hirschprung’s

A
  • family hx
  • Down’s
  • neurofibromatosis
133
Q

presentation: Hirschprung’s

A
  • delay in passing meconium
  • chronic constipation since birth
  • abdominal pain/distension
  • vomiting
  • failure to thrive and vomiting
134
Q

def: Hirschprung’s Associated Enterocolitis (HAEC)

A

inflammation and obstruction of intestine presenting 2-4 weeks of birth with fever, abdominal distension, diarrhoea and fx sepsis
can lead to toxic megacolon and bowel perf

135
Q

rx: HAEC

A

urgent antibiotics
fluid resus
decompression of obstruction

136
Q

rx: Hirschprung’s

A
  • AXR
  • rectal biopsy to confirm diagnosis - absence of ganglionic cells
  • fluid resus
  • surgical removal of aganglionic cells definitive mx
137
Q

def: biliary atresia

A
  • congenital condition
  • section of bile duct narrowed or absent causing cholestasis and preventing excretion of conjjugated bilirubin
138
Q

presentation: biliary atresia

A

significant jaundice (high levels conjugated bilirubin))
persistent jaundice >14 dys in term babies and >21 days prem

139
Q

ix: biliary atresia

A

conjugated bilirubin raised
raised GGT
diagnosis confirmed with cholangiogram (ERCP or operative)

140
Q

rx: biliary atresia

A

Kasai hepatoenterostomy

141
Q

causes: intestinal obstruction

A

Hirschprungs
meconium ileus
oesophageal atresia
duodenal atresia
intussusception
imperforate anus
malrotation with volvulus

142
Q

presentation: intestinal obstruction

A

persistent vomiting (may be bilious(
abdominal pain and distension
failure to pass stools or wind (absolute constipation)
abnormal bowel sounds - tinkling/high pitched or absent

143
Q

diagnosis: intestinal obstruction

A

AXR
dilated loops of bowel
absence of air in rectum

144
Q

rx: intestinal obstruction

A

nil by mouth
drip and suck (Ng tube)
IV fluids

145
Q

def: meconium ileus

A

delayed passage meconium (>24 hours)
often CF
abdominal distension

146
Q

ix: meconium ileus

A

AXR no fluid level as meconium viscid
PR contrast studies may dislodge plugs and be therapeutic

147
Q

rx: meconium ileus

A

PR contrast
NG N-acetyl cysteine
surgery

148
Q

def: oesophageal atresia

A

associated with tracheo-oesophageal fistula
polyhydramnios
may present with choking, cyanotic spells following aspirations
VACTERL

149
Q

def: infantile colic

A

common and benign
<3months
bouts of excessive crying and pulling up of legs
worse in evening

150
Q

signs/symptoms: appendicitis

A
  • central abdominal pain initially moving to RIF
  • tenderness in McBurney’s point
  • Rovsing’s sign
  • loss of appetite
  • N+v
  • guarding
  • rebound and percussion tenderness
151
Q

diagnosis: appendicitis

A
  • clinical presentation and raised inflammatory markers
  • ?CT scan
152
Q

rx: appendicitis

A

appendicetomy

153
Q

viral cause: gastroenteritis

A

rotavirus
norovirus

(adenovirus less common and more subacute diarrhoea)

154
Q

bacterial cause: gastroenteritis

A
  • e-coli 0157 shiga toxin
  • campylobacter jejuni
  • shigella
  • salmonella
  • bacillus cereus
  • stash aureus
  • giardiasis
155
Q

features: ecoli 0157 shiga toxin gastroenteritis

A
  • abdominal cramps
  • bloody diarrhoea
  • vomiting
  • shiga toxin destroys blood cells and leads to haemolytic uraemic syndrome (HUS)
  • abx increases risk of HUS
156
Q

features: campylobacter jejuni gastroenteritis

A
  • “travellers diarrhoea”
  • gram negative bacteria spiral shaped
  • raw/improperly cooked pultry/untreated water/unpasteurised milk
  • incubation 2 to 5 days - symp resolve within 3-6 days
  • abdominal cramps
  • diarrhoea (often bloody)
  • vomiting
  • fever

azithromycin or ciprofloxacin if severe

157
Q

features: shigella

A
  • faeces contaminated drinking water/swimmin pools/ food
  • incubation 1-2 days
  • symtpoms resolve usually around 1 week without treatment
  • blood diarrhoea, abdominal cramps and fever
  • shiga toxin - HUS
  • severe = azithromycin or ciprofloxacin
158
Q

features: salmonella

A
  • eating raw eggs/poultry
  • incubation 12 hours to 3 days
  • symptoms usually resolbe within 1 week
  • watery diarrhoea
  • ?mucus and blood
  • abdominal pain and vomiting
  • abx only in severe cases guided by stool culture and sensitivities
159
Q

features: bacillus cereus

A
  • gram +ve rod
  • inadequately cooked food
  • fried rice
  • toxin cereulide causes abdominal cramping and vomiting within 5 hours of ingestion
  • watery diarrhoea
  • symptoms usually resolve within 24 hours
160
Q

features: giardiasis

A
  • parasite
  • pets, farmyard anuimals
  • cysts from stools of affected animals contaminate food/water
  • feaecal-oral transmission
  • chronic diarrhoea
  • stool microscopy diagnosis
  • metronidazole
161
Q

principles: gastroenteritis rx

A
  • barrier nursing
  • infection control
  • child stays off school for 48 hours after symtpoms completely resolve
  • sample of stool for microscopy, culture and sensitivities
  • fluid challende
  • rehydration solutions
  • may require IV fluids
  • light reintroduction of food
162
Q

complications: gastroenteritis

A
  • reactive arthritis
  • lactose intolerance
  • IBS
  • guillain-barre
163
Q

presentation: constipation

A
  • less than 3 stools pepr week
  • rabbit sropping stools
  • hard stools difficult to pass
  • staining and painful passage of stools
  • overflow soiling
  • hard stools palpable in abdomen
  • abdominal pain
  • holding babnormal posture - retentive posturing
164
Q

def: encopresis

A
  • faecal incontinence - not pathological until 4 y
  • sign of chronic constipation
  • rectum stretched and looses sensation
  • large hard stools remain in rectum and loos sools bypass and leak out
165
Q

rare causes: encoparesis

A
  • spina bifida
  • hirschprung’s disease
  • cerebral palsy
  • abuse
  • etc
166
Q

lifestyle factors: constipation

A
  • habitually not opening bowels
  • low fibre diet
  • poor fluid intake and dehydration
  • sedentary lifestyle
167
Q

red flags: constipation

A
  • not passing meconium
  • neurological signs (esp lower limbs)
  • vomiting
  • ribbon stool (anal stenosis)
  • abnormal anus
  • abnormal lower back/buttocks
  • failure to thrive
  • acute severe abdominal pain/bloating
168
Q

rx: constipation

A

correct any reversible factors - good hydration and high fibre diet
start laxatives (movicol first line)
faecal impaction may require disimpaction (high dose laxatives at first)
encourage and praise going to toilet (schedule visits, bowel diary, star charts)

169
Q

features: chron’s IBD

A

NESTS
* no blood or muscous
* entire GI tract
* skip lesions on endoscopy
* terminal ileum most affected and transmural (full thickness) inflammation
* smoking RF (don’t set the nest on fire)

wight loss strictures and fistulas

170
Q

features: UC IBD

A

CLOSE UP
* continuous inflammation
* limited to colon and rectum
* only superficial mucosa affected
* smoking protective
* excrete blood and mucus
* use aminosalicylates
* primary sclerosing cholangitis

171
Q

presentation: IBD

A
  • perfuse diarrhooea
  • abdominal pain
  • bleeding
  • weight loss
  • anaemia
  • may be systemically unwell during flares with fevers, malaise and dehydration
172
Q

extra-intestinal manifestations: IBD

A
  • finger clubbing
  • erythema nodosum
  • pyoderma gangrenosum
  • episcleritis and iritis
  • inflammatory arthritis
173
Q

ix: IBD

A

faecal calprotectin raised
CRP raised
** endoscopy with biopsy = gold standard **

174
Q

rx: Chron’s

A
  • first line = steroids - oral pred or IV hydrocortisone
  • ?enteral nutrition
  • immunosuppressant - methotrexate, infliximab, azathiprine
175
Q

rx: UC

A

mild-moderate:
first line = aminosalicylate
second line = steroids

severe:
IV hydrocortisone

aminosalicylate to maintain remission

ileostomy ot J-pouch definitive management

176
Q

def: macule

A

<1cm circumcised flat area of discoloration

177
Q

def: patch

A

larger flat area of discoloration

178
Q

def: papule

A

raised palpable area (small <1cm)

179
Q

def: plaque

A

large raised disc lesion

180
Q

def: nodule

A

palpable lesion >1cm

o

181
Q

def: vesicle

A

small blister <0.5cm

182
Q

def: bulla

A

blister >0.5cm

183
Q

def: pustule

A

blister with visible pus

184
Q

def: purpura

A

red/purple non-blanching discoloration secondary to extravasation of red cells

185
Q

def: petechiae

A

purpuric area <2cm

186
Q

def: talangiectasia

A

dilated, visible small blood vessels

187
Q

def: wheal

A

itchy papule

188
Q

pigmented lesion: ABCDE

A

asymmetry
border (irregular/redular)
colour
diameter
evolution of lesion

189
Q

cause and presentation: measles

A
  • measles virus spread by respiratory droplets
  • fever and coryzal symptoms with conjunctivitis
  • symptoms start 10-12 days after exposure
  • Koplik (grey/white spots) on buccal muscosa appear 2 days after fever = pathognomonic
190
Q

rash: measles

A
  • starts behind ears typically and spreads to face 3-5 days after fever
  • Koplik spots in buccal mucosa
191
Q

rx: measles

A
  • self resolving 7-10 days later
  • isolated until 4 days after symptoms resolve
  • notifiable disease
192
Q

complications: meaasles

A
  • pneumonia
  • diarrhoea
  • dehydration
  • encephalitis
  • meningitis
  • vision loss
  • hearing loss
  • death
193
Q

cause and presentation: scarlet fever

A
  • group A strep association - usually tonsilitis
  • caused by exotoxin produced by strep pyogenes
  • red-pink blotchy macular rash with rough sandpaper skin starting on trunk and spreading outwards
  • often have red, flushed cheeks
  • fever/lethargy/flushed face/sore throat/strawberry tongue, cervical lymphadenopathy
194
Q

rx: scarlet fever

A

penicillin V for 10 days
pen allergy: azithro 5 days or clarithro 10 daays
notifiable disease
kept off school until 24hrs after starting abx

195
Q

complications: scarlet fever

A

post-strep glomerulonephritis
acute rheumatic fever

196
Q

cause and presentation: rubella

A
  • highly contagious spread by respiratory droplets
  • symptoms start 2 weeks after exposure
  • milder erythematous macular rash starting on face and spreading to rest of body
  • rash lasts 3 days
  • associated with mild fever, joint pain and sore throat
  • lymphadenopathy behing ears and back of neck
197
Q

rx: rubella

A
  • supportive and self limiting
  • notifiable disease
  • stay off school at least 5 days after rash appears
  • avoid pregnant women
198
Q

complications: rubella

A
  • thrombocytopenia
  • encephalitis
  • congenital rubella syndrome - triad = deafness, blindness and congenital heart disease
199
Q

cause and presentation: slapped cheek syndrome/fifths disease/erythema infectiosum

A
  • parvovirus B19
  • mild fever, coryza and non-specific viral symptoms (muscle aches and lethargy
  • after 2-5days rash appears rapidly as diffuse bright red rash on both cheeks
  • few days later reticular (net like) mildly erythematous rash affecting trunk and limbs appears that can be raised and itchy
200
Q

rx: slapped cheek

A
  • self-limiting
  • rash and syptoms fade over 1-2 weeks
  • plenty of fluids and analgesia
  • no longer infectious after rash formed
  • no need to stay off school
201
Q

complications: slapped cheek

A
  • immunocompromised and pregnancy or haematological condition
  • requrie serology testing to confirm diagnosis - FBC and reticulocyte for aplastic anaemia
  • aplastic anaemia
  • encephalitis/meningitis
  • pregnancy complications inc foetal death
    *
202
Q

cause and presentation: roseola infantum

A

human herpesvirus 6 and less commonly 7
* patietns present 1-2 weeks after infection with high fever (up to 40) comes on suddenly
* lasts for 3-5 days and disappears suddenly
* may be coryzal, sore throat and swollen lymph nodes
* when fever settles, rash appears for 1-2 days of erythematous macular rash on arms, trunk and face - not itchy
* do not need to take off school and oftern recover within 1 week

febrile convulsions

203
Q

cause and presentation: hand, foot and mouth

A
  • coxsackie A virus
  • incubation 3-5 days
  • starts with URTI - tiredness, sore throat, dry cough, fever
  • 1-2 days later ulcers on mouth, blistering red spots on body and hands (palms) and feet (soles) (esp tongue) may be itchy
204
Q

rx: hand, foot and mouth

A
  • supportive
  • adequate fluid intake
  • simple analgesia
  • resolve 7-10days
  • highly contagious - avoid sharing towels/bedding
  • wash hands and careful handling nappies
205
Q

complications: H,F&M

A
  • dehydration
  • bacterial superinfection
  • encephalitis
206
Q

isolation: infectious diseases

A

rubella - 5 days after rash appears
scarlet fever - 24 hours after starting abx
measles - 4 days after symptoms resolve
chicken pox - once all lesions have crusted over

207
Q

cause and presentation: chickenpox

A
  • VZV
  • widespread, erythemaous, raised, vesicular, blistering lesions
  • starts on trunk or face and spreads outwards affecting whole body over 2-5 days
  • fever first symptoms
  • itch
  • general fatigue and malaise
208
Q

infectivity and complciations: chickenpox

A
  • highly contagious and spread through direct contact with lesions or through respiratory droplets
  • bacterial superinfection
  • dehydration
  • conjunctival lesions
  • pneumonitis
  • encephalitis (presenting with ataxia)
  • after infection virus can lie dormant in snsory dorsal root ganglion cells adn cranial nerves - reactivate in later life as shingles or Ramsay Hunt syndrome
209
Q

chickenpox and prgnancy

A
  • pregnant women not immune need VZV immunoglobulins
  • chickenpox before 28 weeks can cause developmental problems in foetus - CONGENITAL VARICELLA SYNDROME
  • chickenpox near delivery can lead to life threatening neonatal infection and treated with VZV immunoglobulins and aciclovir
210
Q

rx: chickenpox

A
  • usually mild and self limiting
  • DO NOT GIVE NEUROFEN - increases risk of necrotising fascitis
  • aciclovir if immunocompromised, over 14 and adults presenting within 24 hours or neonates
  • itching relieved with calamine lotion and chlorphenamine
  • complications like encephalitis require admission
  • patients kept off school and avoid pregnant women until lesions dry and crusted over (around 5 days)

Year 4 Paeds (6 decks)

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