Selected Notes paeds 2 Flashcards
In patients with androgen insensitivity syndrome why don’t female internal organs develop?
Testes produce anti-Mullerian hormone->prevents males from developing upper vagina, uterus, cervix and fallopian tubes
How would hormonal tests look in a patient with androgen insensitivity syndrome?
<ul><li>Raised LH</li><li>Normal/raised FSH</li><li>Normal/raised testosterone (for a male)</li><li>Raised oestrogen(for a male)</li></ul>
How is androgen insensitivity syndrome managed?
<ul><li>Specialist MDT: paeds gynae, urology, endo, psych</li><li>Counselling-generally <b>raised as female</b></li><li>Bilateral orchidectomy(avoid testicular tumours)</li><li>Oestrogen therapy</li><li>Vaginal dilators/surgery to create an adequate vaginal length</li></ul>
Give some examples of learning disabilities
<ul><li>Down's</li><li>ASD and aspergers</li><li>Williams</li><li>Fragile X</li><li>Global developmental delay</li><li>Cerebral palsy</li></ul>
How do children with fragile X present?
<ul><li>Large face</li><li>Large protruding ears</li><li>Intellectual impariment</li><li>Post pubertal macroorchidism</li><li>Social anxiety</li><li>ASD features</li></ul>
Name some differentials for fragile X
<ul><li>ASD(no physical characteristics)</li><li>Down's</li><li>Turner's</li></ul>
How is Fragile X syndrome diagnosed?
<ul><li>Genetics-test number of CGC rpeats in FMR1 gene</li><li>Can also be used to detect carriers</li></ul>
How is Fragile X syndrome treated?
<ol><li>Behavioural therapy->manage social anxiety and ASD features</li><li>SALT for communication</li><li>Educational support</li><li>Medical management for physical complications</li></ol>
Name some differential diagnoses for Kawasaki disease?
<ul><li>Scarlet fever-high fever, strawberry tongue and sandpaper red rash</li><li>Measles</li><li>Drug reactions</li><li>Juvenile rheumaotid arthritis</li><li>Toxic schock syndrome</li></ul>
<b>Kawasaki disease course:</b><br></br>Acute: {{c1::Child most unwell with fever, rash and lymphadenopathy}}<br></br><ul><li>Lasts: {{c1::1-2 weeks}}</li></ul><div>Subacute: {{c2::Acute symptoms settle, demasquation occurs and risk of coronary artery aneurysms forming}}</div><div><ul><li>Lasts: {{c2::2-4 weeks}}</li></ul><div>Convalescent stage: {{c3::Remaining symptoms settle, coronary artery aneurysms may regress}}</div></div><div><ul><li>Lasts: {{c3::2-4 weeks}}</li></ul></div>
How is measles transmitted?
<ul><li>Via droplets from nose, mouth or throat of infected patient</li></ul>
Describe the typical sequence of symptom onset in patients with measles
<ol><li>High fever >40 degrees</li><li>Coryzal symtpoms</li><li>Conjunctivitis</li><li>Koplik spots</li><li>Rash</li></ol>
<br></br>
Name some differential diagnoses for measles
<ul><li>Rubella</li><li>Roseola</li><li>Scarlet fever</li></ul>
How can rubella be differentiated from measles?
<ul><li>Rubella often milder and begins on face then spreads</li></ul>
How long after exposure to measles do symptoms develop?
<ul><li>10-14 days post exposure</li></ul>
Name some complications of measles
<ul><li>Acute otitis media-most common complicaiton</li><li>Pneumonia: most common cause of death</li><li>Encephalitis: typically 1-2 weeks after onset</li></ul>
How is chicken pox spread?
<ul><li>Airborne-direct contact with rasj or breathign in particles form infected person's cough/sneeze</li><li>Can be caught from someone with shingles</li></ul>
How is chicken pox diagnosed?
<ul><li>Clinically</li></ul>
How is rubella transmitted?
<ul><li>Through respiratory droplets</li></ul>
How is rubella diagnosed?
<ul><li>Serology</li><li>rubella-specific IgM or rise in IgG in acute and convalescent serum samples</li></ul>
How is rubella treated?
<ul><li>Supportive: antipyretics and analgesia</li><li>Isolate individuals to prevent spread, escpecially amongst unvaccinated pregnant women</li></ul>
Name some complications of rubella
<ul><li>Arthritis</li><li>Thrombocytopenia</li><li>Encephalitis</li><li>Myocarditis</li></ul>
How does diptheria damag the body?
<ul><li>Diptheria toxin commonly causes a 'diptheric membrane' on tonsils cuased by necrotic mucosal cells</li><li>System distribution can produce necrosis of myocardial, neural and renal tissue</li></ul>
How might a patient with diphtheria present?
<ul><li>Recent visitor to Eastern europe/russia/asia</li><li>Sore throat with 'diphtheric membrane'</li><li>Bulky cervical lymohadenopathy</li><li>Neuritis</li><li>Heart block</li></ul>
How is a patient diagnosed with diphtheria?
<ul><li>Culture of throat swab-Use tellurite or Loeffler's media</li></ul>
How is diphtheria managed?
<ul><li>Intramuscular penicillin</li><li>Diphtheria antitoxin</li></ul>
How can scalded skin syndrome be differentiated from toxic epidermal necrolysis(TEN)?
Scalded skin syndrome: oral mucosa usually unaffected
Name some differential diagnoses for scalded skin syndrome
<ul><li>Toxic Epidermal Necrolysis (TEN): manifests with widespread erythema and necrosis, leading to detachment of the epidermis. It involves mucous membranes, which differentiates it from SSSS</li><li>Pemphigus vulgaris: characterised by flaccid blisters and erosions on the skin and mucous membranes; Nikolsky sign is also positive</li><li>Bullous Impetigo: typically presents with localized bullae filled with pus, often with surrounding erythema and tenderness</li></ul>
How is scalded skin syndrome diagnosed?
<ul><li>Usually clinical</li><li>Biopsy can help deifferentiate from TEN</li><li>Cultures: presence of S aureus</li></ul>
How is scalded skin syndrome treated?<br></br>
<ol><li>IV antibiotics: flucloxacillin-inhibits toxin synthesis</li><li>Supprtoive: fluid replacement and pain management</li><li>Wound care to prevent secondary infections</li></ol>
How does flucloxacillin treat scalded skin syndrome?
<ul><li>Prevents toxin synthesis</li></ul>
How do patients with whooping ocugh present?
<ul><li>Apasmodi coughing with a prolonged duration per episode</li><li>Inspiratory whooping sound</li><li>Rhinorrhoea</li><li>Post-tussive vomiting</li><li>Apnoeas, especially in infants</li></ul>
Name some consequences of persistent coughing in patient with whooping cough
<ul><li>May develop subconjunctival haemorrhages or anoxia leading to syncope or seizures</li></ul>
How do infants with whooping cough often present?
Apnoeas
How is whooping cough managed?
<ul><li>Oral macrolide: clarithromycin, azithromycin etc if cough onset within 21 days</li><li>Notify public health</li><li>Antibiotic prophylaxis to household contacts</li></ul>
How do macroldies help patients with whooping cough?
<ul><li>Don't alter disease course, byt may alleviate symptoms and minimise transmission</li></ul>
Name 4 enteroviruses
<ul><li>Coxsackie A</li><li>Coxsackie B</li><li>Poliovirus</li><li>Echorviruses</li></ul>
How do enteroviruses spread?
<ul><li>Faeco-oral or droplet transmission</li></ul>
How do patients with polio present?
<ul><li>Most commonly asymptomatic</li><li>Minor: flu-like, pain, fever fatigure, headache, vomiting</li><li>Major: Acute flaccid paralysis-> bulbar paralysis</li></ul>
How is polio diagnosed?
<ul><li>Clinical</li><li>Lab: stool, throat swab, CSF analysis</li></ul>
How is polio managed?
<ul><li>No cure</li><li>Supportive: pain relief, ventilation if breathing difficulties etc</li><li>Physio: in cases of paralytic polio</li><li>Preventativbe: vaccination</li></ul>
Name some complications of polio
<ul><li>Paralysis, disability and deformities</li><li>Respiratory issues: from bulbar polio</li><li>Post-polio syndrome: years after initial infection-> muscle weakness, fatigue and pain in previously affected muscles</li></ul>
Name osme viral causes of meningitis
<ul><li>Enteroviruses</li><li>HSV</li><li>HIV</li></ul>
Describe the typical presentation of a child with fifth disease
<ul><li>Prodrome of mild fever, coryza, diarrhoea</li><li>Characteristic bright red rash on cheeks after a few days-can spread to rest of body but rarely involved palms and soles-peaks after a week then fades</li></ul>
How is fifth’s disease spread
Via respiratory route
name some differentials for fifths disease
<ul><li>Rubella: presents with a similar rash, but also includes lymphadenopathy and conjunctivitis</li><li>Scarlet fever: presents with a similar rash, but also includes a sore throat and a 'strawberry' tongue</li><li>Roseola: presents with a high fever followed by a rash, but the rash is typically non-pruritic and pink in colour</li></ul>
How is fifth’s disease diagnosed?
<ul><li>Usually clinical</li><li>Atypical: serological testing for Parvovirus B19</li><li>FBC: low reticuloycte</li></ul>
How is pneumonia manged?
<ul><li>At home: analgesia, rest, fluids etc</li><li>Hospital: IV fluids and oxygen and antibiotics</li></ul>
How is pneumonia in neonates managed?
<ul><li>IV fluids</li><li>Oxygen</li><li>Broad spectrum antibiotics</li></ul>
How is pneumonia in infants managed?
<ul><li>IV fluids</li><li>Oxygen</li><li>Amoxcicillin/co-amoxiclav if severe</li></ul>
How is pneumonia in children aged >5 years managed?
<ul><li>IV fluids</li><li>Oxygen</li><li>Amoxicillin/erythromycin</li></ul>
Name a complication of pneumonia in children
<ul><li>Parapenumonic collapse and empyema</li></ul>
How do patients with asthma typically present?
<ul><li>Episodic wheeze that is persistent most days and night</li><li>Dry cough</li><li>SOB</li><li>Symptoms worse at night and early morning</li><li>Symptoms have trriggers: exercise, pets, dust, cold air, laughing</li><li>Interval symptoms</li></ul>
How would you describe a wheeze to a parent?
<ul><li>Whistling in chest when your child breathes out</li></ul>
Name some respiratory failure red flags
<ul><li>Drowsiness</li><li>Cyanosis</li><li>Laboured breathing</li><li>Lethargy</li><li>Tachycardia</li><li>Use of accessory muscles </li></ul>
Name some important features to assessing a child presenting with a wheeze
<ul><li>Fever</li><li>Weight loss</li><li>Apnoea</li><li>LOC</li><li>CYanosis</li><li>O2</li><li>Hepatomegaly</li><li>Breathing: too breathless to feed, hyperinflation/recession, use of accessory muscles, nasal falring, auscultation/percussion</li><li>Heart rate >160bpm</li><li>Murmur?</li></ul>
Name some causes of a wheeze in children
<ul><li>Asthma</li><li>Bronchiolitis</li><li>Penumonia</li><li>Transient early wheezing</li><li>Non atopic wheezing</li><li>Cardiac failure</li><li>Inhaled foreign body</li><li>Aspiration of feeds</li><li>Cystic fibrosis</li><li>Congenital abnormality of lung, airway and heart</li></ul>
How is moderate acute asthma treated?
<ul><li>SABA via spacer, 2-4 puffs</li><li>Consider oral prednisolone</li><li>Reassure</li></ul>
How long do symptoms of croup typically last?
<ul><li>48 hours to 1 week</li></ul>
Name some complications of croup
<ul><li>Airway obstruction-> trachea intubation</li><li>Otitis media</li><li>Dehydration form decreased fluid intake</li><li>Superinfection resulting in pneumonia</li></ul>
How might a patient with bacterial tracheitis present?
<ul><li>High fever</li><li>Toxic</li><li>Rapidly progressing into airway obstruction and thick airway secretions</li></ul>
How common is bronchiolitis?
<ul><li>Most common serious respiratory infection of infancy</li></ul>
Name some causes of bronchiolitis and which is the most common?
<ul><li>RSV-80% of cases</li><li>Parainfluenza. rhinovirus, adenovirus, mycoplasma pneumoniae</li></ul>
Name some risk factors for bronchiolitis
<ul><li>Breastfeeding for <2 months</li><li>Older siblings at nursery/school</li><li>Smoke exposure</li><li>Chronic lung disease of prematurity</li></ul>
How is bronchiolitis diagnosed?
<ul><li>Most clinical</li><li>Nasopharyngeal aspirate for RSV culture</li><li>CXR</li><li>If severe: blood gas analysis, continurous O2 monitoring</li></ul>
Name a risk factor for developing bronchiolitis obliterans
<ul><li>Lung transplant recipients</li></ul>
If both parents carry the gene for cystic fibrosis, what are the chances the child will have CF?
36895
If both parents carry the gene for cystic fibrosis, what are the chances the child will be a carrier?
36893
If both parents carry the gene for cystic fibrosis, what are the chances the child won’t have CF or be a carrier?
36895
If 1/25 people in UK have CF mutation, what are the cahnces of having a child with CF?
1/2500<br></br><ul><li>1/25 x 1/25 x 1/4</li></ul>
How do neonates with cystic fibrosis typically present?
<ul><li>Meconium ileus due to viscous meconium</li><li>Failure to thrive</li></ul>
How do infants and toddlers with CF typically present?
<ul><li>Salty sweat</li><li>Faltering growth</li><li>Chest infection</li><li>Malabsorption</li></ul>
How do older children with CF present?
<ul><li>Delayed onset of puberty</li><li>Chest infections</li><li>Malabsorption</li></ul>
How is CF diagnosed?
<ul><li>Screening: neonatal blood spot test: high immunoreactive trypsinogen</li><li>Sweat test: high chloride</li><li>Genetic testing</li></ul>
How is CF managed?
<ul><li>Daily chest physio to clear mucus and prevent pneumonia</li><li>Prophylactic antibiotics, bronchodilators and meds to thin secretions </li><li>Regular immunisations-> influenza, penumococcla vaccines</li><li>Pancreatic enzyme replacement(Creon) and fat soluble vitamin supplementation (ADEK)</li><li>Bilateral lung transplant in end stage pulmonary disease</li></ul>
Name some complications of cystic fibrosis
<ul><li>Malabsorption and diabetes due to decreased pancreatic enzyme function</li><li>Liver failure</li><li>Chest infections-> pneumothoraz and life threatening haemoptysis</li></ul>
How does CF cause liver failure?
<ul><li>Mucus blocks bile ducts-> bile can't leave liver</li></ul>
How common is acute epiglottitis?
<ul><li>Rare now due to HiB vaccine</li></ul>
How do patients with acute epiglottitis present?
<ul><li>Rapid onset and increase in respiratory difficulties</li><li>High fever, generally very unwell/toxic</li><li>Minimal.absent cough</li><li>Soft inspiratory stridor</li><li>Intesne throat pain</li><li>DROOLING</li><li>TRIPOD POSITION-> leant forward, extending neck, open mouth</li></ul>
Name some differentials for acute epiglottitis
<ul><li>Croup</li><li>Peritonsillar abscess</li><li>Bacterial tracheitis</li><li><br></br></li></ul>
How do patients with a viral induced wheeze present?
<ul><li>Viral illness for 1-2 days preceding onset</li><li>SOB</li><li>Signs of respiraotry distress</li><li>Expiratory wheeze throughout the chest</li></ul>
How is multiple trigger wheeze treated?
<ul><li>Trial ICS/LTRA for 4-8 weeks</li></ul>
How do patients with otitis media typically present?
<ul><li>Otalgia(ear pain)</li><li>Fever</li><li>Hearing loss</li><li>Recent URTI symptoms</li><li>Discharge</li></ul>
Name some differential diagnoses for otitis media?
<ul><li>URTI</li><li>Mastoiditis</li><li>Otitis externa</li><li>Foreign body</li></ul>
How is otitis media managed?
<ul><li>Self-resolving: usually no antibiotics needed, simple analgesia</li><li>If no improvement after 3 days: can start antibiotics</li><li>In severe cases admit to hospital and antibiotics</li></ul>
Name some complications of otitis media
<ul><li>Chronic OM</li><li>Tympanic membrane perforation</li><li>Meningitis</li><li>Mastoidits</li><li>Facial nerve palsy</li><li>Labyrinthitis</li></ul>
How can otitis media be prevented?
<ul><li>Avoid passive smoking</li><li>Avoid flat/supine feeding</li><li><br></br></li></ul>
How do patients with glue ear typically present?
<ul><li>Hearing loss in affected ear</li></ul>
How is glue ear diagnosed?
<ul><li>Otoscopy-> dull tympanic membrane with air bubbles or visible fluid level(can look normal), retracted eardrum</li></ul>
Name some of the risk factors for periorbital cellulitis
<ul><li>Male</li><li>Previous sinus infection</li><li>Recent eyelid injury</li></ul>
How do patients with periorbital cellulitis present?
<ul><li>Acute onset of red, swollen, painful eye, fever</li><li>Eryhtema and oedema of eyelids-> can spread to surrounding skin</li><li>Partial.complete ptosis of eye due to swelling</li><li>Orbital signs ABSENT(no pain/restriction on movement, proptosis, chemosis etc)</li></ul>
Name some differentials for periorbital cellulitis
<ul><li>Orbital cellulitis</li><li>Allergic reactions</li></ul>
How is periorbital cellulitis managed?
<ul><li>Referral to secondary care assessment</li><li>Oral antibiotics usually enough-> empirical co-amoxiclav/cefotaxime</li><li>May require admission for observation</li></ul>
Name some causes of a squint
<ul><li>Idiopathic-most common</li><li>Hydrocephalus</li><li>Cerebral palsy</li><li>Space occupying lesion(retinoblastoma)</li><li>Trauma</li></ul>
Name some differential diagnoses for impetigo?
<ul><li>Eczema herpeticum</li><li>HSV infection</li><li>Contact dermatitis</li><li>Ringworm</li></ul>
How is impetigo diagnosed?
<ul><li>Usually clinically</li><li>Skin swab for mc+s in certain cases like recurrent infections or treatment resistant cases</li></ul>
Name some complications of impetigo
<ul><li>Sepsis</li><li>Glomerulonephritis</li><li>Deeper soft tissue infection-cellulitis</li><li>Scarring</li><li>Post strep glomerulonephritis</li><li>Scarlet fever</li><li>Staphyloccocus scalded skin syndrome</li></ul>
Name some differentials for toxic shock syndrome
<ul><li>Meningococcal scepticaemia</li><li>Stevens-Johnson syndrome</li><li>Kawasaki disease</li></ul>
How is suspected toxic shock syndrome investigated?
<ul><li>Sepsis 6</li><li>Throat/wound swabs</li></ul>
How is scarlet fever spread?
<ul><li>Via respiratory route-> inhaling or ingesting droplets or direct contact with nose and throat discharge</li></ul>
How is scarlet fever diagnosed?
<ul><li>Throat swab</li><li>DONT wait for results to start anitbiotic treatment</li></ul>
Describe the treament of scarlet fever
<ul><li>Oral phenoxymethylpenicillin for 10 days</li><li>Azithromycin for penicillin allergy</li><li>notifiable disease-report to public health</li><li>Keep off school</li></ul>
How long do patients with scarlet fever need to stay off school?
<ul><li>Until 24 hours after commencing antibiotics</li></ul>
Name some complications of scarlet fever
<ul><li>Rheumatic fever</li><li>Post strep glomerulonephritis</li><li>Otitis media-most common</li><li>Invasive complications-meningitis, bactaraemia etc</li></ul>
How does the ductus venosus close?
Immediately after birth-> umbilical cord clamped and no blood flow-> closes and becomes ligamentim venosum
How does the ductus arteriosus close?
<ul><li>Prostalgandins usually keep it open</li><li>Increased blood oxygenation-> drop in circulating prostaglandins->closes</li><li>Becomes ligamentum arteriosum</li></ul>
How does the foramen ovale close?
<ul><li>First breath->alveoli expand-> decrease pulmonary resistance in right atrium</li><li>Left atrial pressure>right atrial pressure-> squashes septum and closes</li><li>Sealed shut after a few weeks-> fossa ovalis</li></ul>
Name some differentials for an ejection-systolic murmur
<ul><li>Aortic stenosis</li><li>Pulmonary stenosis</li><li>Hypertrophic obstructive cardiomyopathy</li></ul>
Name some causes/risk factors for a patent ductus arteriosus(PDA)
<ul><li>Genetics/related to rubella</li><li>Prematurity</li></ul>
How might a patent ductus arterious present in a newborn?
<ul><li>Incidentally in neworn exam with murmur</li><li>SOB</li><li>Difficulty feeding</li><li>Poor weight gain</li><li>Lower respiratory tract infections</li></ul>
In patients with a PDA that don;t present in childhood, how might they present in adulthood?
<ul><li>With heart failure later in life</li></ul>
How is a PDA diagnosed?
<ul><li>Echo</li><li>Left to right shunt</li><li>Hypertrophy of right, left or both ventricles</li></ul>
How are patients with PDA;s managed?
<ul><li>Usualy close by themselves, no treatment if no symptoms</li><li>Medical: NSAIDs</li><li>Monitored with echos until 1 year</li><li>Symptomatic or severe or after 1 year if hasn't closed spontaneously-> trans-catheter or surgical closure</li></ul>
How do NSAIDS work to treat PDA’s?
Inhibit prostaglandin synthesis (helps maintain ductal patency)
How might a patient with an atrial septal defect present?
Childhood:<br></br><ul><li>SOB</li><li>Difficulty feeding</li><li>Poor weight gain</li><li>Lower respiratory tract infections</li><li>Asymptomatic-> antenatal scans</li></ul><div>Adulthood:</div><div><ul><li>Dsypnoea</li><li>Heart failure</li><li>Stroke</li></ul></div>
How are atrial septal defects managed
<ul><li>Small: watch and wait</li><li>Surgery: transvenous catheter closure or open heart surgery</li><li>Medical: anticoagulatns like aspiring, warfirin and NOACs</li></ul>
How are patients with critical coarctation of the aorta managed at birth?
<ul><li>Prostaglandin E used to keep ductus arteriosus open while waiting for surgery</li><li>Surgery to correct coarctation and ligate ductus arteriosus</li></ul>
How are VSDs diagnosed?
<ul><li>Typically through antenatal scans or newborn baby check</li><li>Can be asymptomatic and present later in life </li></ul>
How are VSD’s managed?
<ul><li>Small and asx: watch and wait, may close spontaneously</li><li>Surgically: transvenous catheter closure via femoral vein or open heart surgery</li></ul>
How does the VSD contribute to the tetralogy of fallot?
<ul><li>Blood can flow between ventricles</li></ul>
How does the overriding aorta contribute to tetralogy of fallot?
<ul><li>When right ventricle contracts, aorta is in direction of travel of that blood, greated proportion of deoxygentated blood enters aorta</li></ul>
How does stenosis of the pulmonary valve contribute to tetralogy of fallot?
<ul><li>Greater resistance against flow of blood form right ventricle</li><li>Blood flows through VSD and into aorta instead of pulmonary vessels</li><li>Due ot overriding aorta and pulmoanry stenossi-> blood is shunted from right to left-> cyanosis</li></ul>
How can positional changes improve circulation in tet spells?
<ul><li>Older children: squat</li><li>Younger children: Bring knees to chest</li><li>Increases systemic vascular resistance so encourages blood to enter pulmonary vessels</li></ul>
How is tetralogy of fallot managed in neonates?
<ul><li>Prostaglandin infusion to maintain ductus arteriosus: allows blood to flow from aorta back to pulmonary arteries</li><li>Total surgical repair-mortality around 5%</li></ul>
How does sodium bicarbonate help treat a tet spell?
<ul><li>Buffers any metbaolic acidosis</li></ul>
Describe the symptoms of transposition of the great arteries
<ul><li>Cyanosis at/shortly after birth</li><li>Tachypnoea</li><li>Poor feeding/weight gain</li></ul>
How is transposition of the great arteries diagnosed?
<ul><li>Fetal US-most are picked up antenatally</li><li>Echo</li><li>CXR-egg on side</li></ul>
Describe the treatment of transposition of the great arteries
<ul><li>Prostaglandin E infusion-maintain ductus arteriosus</li><li>Balloon septostomy</li><li>Definitive: open heart surgery using bypass-arterial switch</li></ul>
How is Ebstein’s anomaly treated?
<ul><li>Treat arrhythmias and heart failure</li><li>Prophylactic antibiotics to prevent infective endocarditis</li><li>Surgical correction: definitive</li></ul>
How is congenital aortic valve stenosis diagnosed and monitored?
<ul><li>Echo: GS</li><li>Monitoring: echo, ECG, exercise testing</li></ul>
Desrcibe the treatment for congenital aortic valve stenosis
<ul><li>Percutaneous balloon aortic valvoplasty</li><li>Surgical aortic valvotomy</li><li>Valve replacement</li></ul>
Name some complications that can aride from congenital aortic valve stenosis
<ul><li>Left ventricular outflow tract obstruction</li><li>Heart failure</li><li>Ventricular arrhythmia</li><li>Bacterial endocarditis</li><li>Sudden death-on exertion</li></ul>
How is congenital pulmonary valve stenosis diagnosed?
<ul><li>Echo</li></ul>
Name some possible causes of nocturnal enuresis
<ul><li>Daibetes-> excessive urination</li><li>UTI's-> urgency/frequency</li><li>Constipation-> compressess bladder</li></ul>
How can haemolytic uraemic syndrome be classified?
<ol><li>Secondary/typical</li><li>Primary/atypical</li></ol>
Name a differential diagnosis for haemolytic uraemic syndrome and explain how they can be dfferentiated?
<ul><li>Thrombotic thrombocytopenic purpura(TTP)</li><li>TTP will include symptoms of fever and neurological changes</li></ul>
How is typical haemolytic anaemia managed?
<ul><li>Supportive-> fluids, blood transfusions and dialysis if needed</li><li>NO antibiotics</li></ul>
How is atypical haemolytic uraemic syndrome managed?
<ul><li>Referral to specialist</li><li>Treatment with eculizumab(monoclonal antibody)</li><li>Plasma exchange may be used in severe cases with no diarrhoea</li><li>NO antibiotics</li></ul>
How does eculizumab treat haemolytic uraemic syndrome?
Monoclonal antibody-> inhibits the terminal complement pathway
How should urine samples be collected in children with a suspected UTI?
<ul><li>Clean catch</li><li>Non contaminated collection pad/catheter sample/suprapubic aspiration</li></ul>
Name some complications of a UTI
<ul><li>Renal scarring and CKD</li><li>Sepsis</li></ul>
How does vesicoureteric reflux result in recurrent UTI’s?
<ul><li>Backwards flow carries bacteria up to the kidneys</li></ul>
Give 3 causes of a vesicoureteric reflux
<ul><li>Shortened intravesical ureter</li><li>Impoperly functioning valve where ureter joins bladder</li><li>Neurological disorder affecting the bladder</li></ul>
Name some complicaiton of vesicoureteric reflux
<ul><li>Recurrent UTI's</li><li>Pyelonephritis</li><li>Renal scarring and UTI's</li><li>Hypertension</li></ul>
<b>Grading of </b>vesicoureteric reflux<br></br>Grade 1: {{c1::Incomplete filling of upper urinary tract without dilatation}}<br></br>Grade 2: {{c2::Complete filling +/- slight dilatation}}<br></br>Grade 3: {{c3::Ballooned calyces}}<br></br>Grade 4: {{c4::Megaureter}}<br></br>Grade 5: +{{c5::hydronephrosis}}
Name some conditions Wilms’ tumour is associated with
<ul><li>Beckwith-Wiedemann syndrome</li><li>WAGR syndrome(Wilms', aniridia, GU anomalies, mental retardation)</li><li>Denys-Drash syndrome: WT1 gene on CH 11</li></ul>
Name some differential diagnoses for a Wilms’ tumour
<ul><li>Neuroblastoma</li><li>Mesoblastic nephroma</li><li>Renal cell carcinoma-> rare in children</li></ul>
Name one poor prognostic factor in a patients with Wilms’ tumour
<ul><li>Associations with other genetic conditions</li></ul>
Name some risk factors for cryptorchidism
<ul><li>Family history</li><li>Small for gestational age</li><li>Prematurity</li><li>Low brith weight</li><li>Maternal smoking in pregnancy</li></ul>
Name some conditions associated with cryptorchidism
<ul><li>Cerebral palsy</li><li>Wilms' tumour</li><li>Abdominal wall defects</li></ul>
How is cryptorchidism diagnosed?
<ul><li>Cinical-physical exam in a supine position</li></ul>
How might a patient with cryptorchidism present?
<ul><li>Malpositioned/absent testes/testis</li><li>Palpable cryptorchid testis(unable to be pulled into scrotum/returns to higher position after pulling)</li><li>Non-palpable testis</li><li>Testicular asymmetry/scrotal hyperplasia</li></ul>
Name some differential diagnoses for cryptorchidism
<ul><li>Rretractile testis</li><li>Intersex conditions</li></ul>
How would a teenager presenting with cryptorchidism be managed?
<ul><li>Orchidectomy</li><li>Due to a higher risk of malignancy-Sertoli cells degrade after 2 years</li></ul>
Name some complications of hypospadias
<ul><li>Difficulty directing urination</li><li>Cosmetic and psychological reasons</li><li>Sexual dysfunction</li></ul>
Name some complications of phimosis/paraphimosis
<ul><li>Recurrent balanoposthitis/UTI's</li><li>Venous congestion, oedema and ischaemia of glans penis</li></ul>
Name some primary causes of nephrotic syndrome
<ol><li>Minimal change disease</li><li>Focal segmental glomerulonephropathy</li><li>Membranous nephropathy</li></ol>
How does nephrotic syndrome result in an increased risk of thrombosis?
<ul><li>Decreased antithrombin 3, proteins c+s and increase in fibrinogen</li></ul>
How doe nephrotic syndrome result in lower thyroxine?
<ul><li>Decreased thyroxine binding globulin-> lowers total(not free) thyroxine</li></ul>
Name some complications of nephrotic syndrome
<ul><li>Hypovolaemia->oedema and hypotension</li><li>Thrombosis-> kiedney leak clotting factors</li><li>Infection-> kidenys leak Ig's and steroid use</li><li>Acute/renal failure</li></ul>
Name 2 drugs that can cause minimal change disease
<ul><li>NSAIDs</li><li>Rifampicin</li></ul>
Name some causes of nephritic syndrome
<ul><li>AI: SLE oe Henoch Schonlein purpura</li><li>Infections: post strep</li><li>Goodpasture's disease</li><li>IgA nephropathy(Berger's)</li><li>Rapidly progressing glomerulonephrotos</li><li>Membranoproliferative glomerulonpehritis</li></ul>
Describe the typical presentation of a patient with IgA nephropathy
<ul><li>Gross/microscopic haematuria occuring 12-72 hours after an URTI or GI infection</li><li>Mild proteinuria</li><li>Hypertension</li></ul>
<div><br></br></div>
Name some differential diagnoses for IgA nephropathy
Post strep glomerulonephritis(weeks post infection not days, IgA deposition)<br></br>Henoch Schonlein purpura-> same excpet systemic IgA complex deposition instead of just kidneys<br></br>
Name some markers of good prognosis and poorer prognosis of patient with IgA nephropathy
Good: frank haematuria<br></br>Poor: male, proteinuria, hypertension, smoking, hyperlipidaemia
Name some differential diagnoses for post strep glomerulonephritis
<ul><li>IgA nephropathy</li></ul>
Name a complication of post strep glomerulonephritis
<ul><li>CKD</li><li>Rapidly progressing glomerulonephritis</li></ul>
Goodpastures disease: symptoms, cause,and treatment
Symptoms: pulmonary and alveoli haemorrhage<br></br>Cause: Anti-GBM antibody deposition<br></br>Treatment: Steroids and plasma exchange
Name some causes of rapidly progressinve glomerulonephritis
<ul><li>Goodpasture's</li><li>IgA nephropathy</li><li>Henoch Schonlein Purpura</li><li>Lupus nephritis</li><li>Wegener's granulomatosis</li></ul>
Describe the treatment of rapidly progressive GN
<ul><li>Corticosteroids and cyclophosphamide-> induce remission</li><li>Plasmapharesis-> anti GBM disease and severe ANCA associated vasculitis</li><li>Supportive: BP control, diet changes, manage fluid overload/electrolyte imbalances</li><li>Renal replacement therapy may be required</li></ul>
How can hypogonadism be classified?
<ul><li>Primary: testicular failure</li><li>Secondary: hypothalamci or pituitary disorders</li></ul>
Give some examples of primary hypogonadism
<ul><li>Klinefelter syndrome</li><li>Orchitis</li><li>Testicular trauma/torsion</li><li>Chemo/radioation</li></ul>
Give some examples of secondary hypogonadism
<ul><li>Kallmannm syndrome</li><li>Pituitary adenomas</li><li>Hyperprolactinoma</li><li>Anorexia</li><li>Opioid use</li><li>Glucocorticoid use</li><li>HIV/AIDS</li><li>Haemochromatosis</li></ul>
Name some differential diagnoses for hypogonadism
<ul><li>Depression</li><li>Thryoid disorders</li><li>CFS</li></ul>
How might hormone levels seem different in those with Klinefelter syndrome?
<ul><li>Elevated gonadotrophin levels(FSH, LH etc)</li><li>Low testosterone</li></ul>
How is Klinefelter diagnosed?
<ul><li>Karyotyping-chromosomal analysis</li><li>Hormones will also show high gonadotrophin levels and low testosterone</li></ul>
Describe the treatment of Klinefelter syndrome
<ul><li>Testosterone injections-improve many symptoms</li><li>Advanced IVF techniques-> fertility options</li><li>Breast reduction for cosemsis</li><li>MDT input: SALT, OT, physio, educational support</li></ul>
How is Turner’s syndrome diagnosed?
<ul><li>Pre-natally: amniocentesis or chorionic villus sampling(CVS)</li><li>Definitive: karyotyping after birth</li></ul>
Give some features of Down’s syndrome that aren’t on the face
<ul><li>Hypotonia</li><li>Pronounced sandal gap</li><li>Learning difficulties</li><li>Short stature</li><li>Congenital heart defects</li><li>duodenal atresia</li><li>Hirschsprung's disease</li></ul>
Name some cardiac complications of Down’s sydnrome
<ul><li>Endocardial cushion defect</li><li>VSD(30%)</li><li>Secundum atrial septul defect</li><li>Tetralogy of fallot</li><li>Isolated PDA</li></ul>
Name some later complications of Down’s syndrome
<ul><li>Subfertility</li><li>Learning difficultires</li><li>ALL</li><li>Alzheimer's</li><li>Repeated respiratory infections</li><li>Antlantoaxial instability-avoid trampolines</li><li>Hypothyroidism</li><li>Visual problems: myopia, strabismus, cataracts</li></ul>
How can Down’s syndrome be diagnosed?
<ul><li>Antenatal screening: between 10-14 weeks</li><li>Combined test: 10-14 weeks: US and maternal bloods</li><li>Triple test: 14-20 weeks: maternal blood tests</li><li>Quadruple test: 14-20 weeks</li></ul>
Give some examples of muscular dystrophies
<ul><li>Duchenne muscular dystrophy</li><li>Beckers muscular dystrophy</li><li>Myotonic musclar dystrophy</li></ul>
If a mother is a carrier for Duchenne muscular dystrophy and has a child, what it the likelihood that the child will be a carrier or have the condition?
If female: 50% chance of being a carrier<br></br>If male: 50% chance of haviing condiiton
How is Duchenne muscular dystrophy managed?
<ul><li>Mostly supportive</li><li>Oral steroids can slow the progression of muscle weakness</li><li>Creatine supplementation can slightly improve muscle stength</li></ul>
How is Becker’s muscular dystrophy different to duchenne muscular dystrophy?
<ul><li>Dystrophiin gene less severely affected and maintains some function, symptoms appear later(8-12 years), some patients need wheelchairs in late 20s/30s, others can walk into adulthood</li></ul>
How is William’s syndrome diagnosed?
<ul><li>FISH studies(fluorescence in situ hybridization)</li></ul>
Desrcibe the epidemiology of rickets
<ul><li>More common in regions of asia and africa</li><li>Asia: lack of sunlight and low vegetable and meat diets</li><li>Africa: darker skin pigmentatino and reduced vitamin D synthesis</li></ul>
Name some predisposing features to rickets
<ul><li>Dietary deficiency of calcium, e.g. in developing countries</li><li>Prolonged breastfeeding</li><li>Unsupplemented cow's milk formula</li><li>Lack of sunlight</li></ul>
Name some differential diagnoses for transient synovitis
<ul><li>Septic arthritis</li><li>Ostemyelitis</li></ul>
How is transient synovitis diagnosed?
<ul><li>Often clinical diagnosis</li><li>Normal basic observations</li><li>Normal blood tests with no raised WCC or inflammatory markers</li><li>USS: may show effusion, X-ray normal</li><li>Joint aspirate: if done should be no bacteria present</li></ul>
How cam mosteomyelitis be classified?
<ul><li>Haematogenous spread: commonly occurs in children, spreads from elsewhere(bactaraemia)</li><li>Non-haematogneous spread: spreads from adjacent soft tissues/from firect injury/trauma to bone</li></ul>
Name some risk factors for haematogenous osteomyelitis
<ul><li>Sickle cell anaemia</li><li>IVDU</li><li>Immunosuppresion</li><li>Infective endocarditis</li></ul>
Name some differentials for osteomyelitis
<ul><li>Septic arthritis</li><li>Ewing sarcoma</li><li>Cellulitis</li><li>Gout</li></ul>
Name some risk factors for developing septic arthritis?
<ul><li>Pre-existing joint diseases like rheumatoid arthritis</li><li>CKD</li><li>Immunosuppresive states</li><li>Prosthetic joints</li></ul>
Name some complications of septic arthritis
<ul><li>Osteomyelitis</li><li>Chronic arthritis</li><li>Ankylosis</li></ul>
Name some differential diagnoses fro Perthes’ disease
<ul><li>Transient synovitis</li><li>Septic arthritis</li><li>SUFE</li><li>JIA</li></ul>
Name 2 complications of Perthes’ disease
<ul><li>Osteoarthritis</li><li>Premature fusion of the growth plates</li></ul>
How does the femoral head get displaced in Slipped Upper Femoral Epiphysis
<ul><li>Displaced posterio-inferiorly</li><li><img></img><br></br></li></ul>
Name some differentials for the diagnosis of slipped upper femoral epiphysis
<ul><li>Osteoarthritis</li><li>Hip fracture</li><li>Specit arthritis</li></ul>
How is slipped upper femoral epiphysis diagnosed?
<ul><li>AP and lateral(typically frog leg) views are diagnostic: shortened, displaced epiphysis and widened growth plate</li><li>Normal blood tests: exclude other causes of joint pain</li><li>Technetium bone scam CT, MRI</li></ul>
Name some complications of slipped upper femoral epiphysis
<ul><li>Osteoarthritis</li><li>Avascular necrosis of the femoral head</li><li>Chrondrolysis</li><li>Leg length discrepancy</li></ul>
How is osgood schlatter diagnosed?
<ul><li>Moslty clinical</li><li>Imaging may be used to rule out other conditions or if symptoms persist</li></ul>
How is osgood schlatter managed?
<ul><li>Pain control with analgesics and modification of physical activities</li><li>NSAIDs for short term relief</li><li>Physio; strengthening and stretching exercises for quadriceps or hamstring muscles</li><li>If severe: knee brace or cast</li></ul>
Name one complication of osgood schlatter
<ul><li>Complete avulsion fracture</li><li>Tibial tubersoity is separated frm the rest of the tibia-> requires surgical intervention</li></ul>
Name some risk factors for developing developmental dysplasia of the hip
5F’s<br></br><ul><li>Female(6 times mroe likely)</li><li>Firstborn</li><li>Family history</li><li>Frank breech presentation(buttocks or feet first in the womb)</li><li>Fluid(oligohydramnios)</li></ul>
How might infants with developmental dysplasia of the hip present?
<ul><li>Limited hip abduction, especially in flexion</li><li>Asymmetry of gluteal and thigh skinfolds</li><li>Apparent limb length discrepancy</li></ul>
How might older children with developmental dysplasia of the hip present?
<ul><li>Walking difficulties/limp</li><li>Delayed walking</li><li>Waddling gait in bilateral cases</li></ul>
How is developmental dysplasia of the hips diagnosed?
<ul><li>USS of hips</li><li>>4.5 months then x-ray</li></ul>
Name a complication of Still’s disease
<ul><li>Macrophage activation syndrome(MAS)</li><li>Severe aactivation of the immune system with a massive inflammatory response</li></ul>
How might a patient with macrophage activation syndrome present?
<ul><li>Systemically unwell</li><li>DIC</li><li>Anaemia</li><li>Thrombocytopenia</li><li>Bleeding</li><li>Non-blanching rash</li><li>Life-threatening</li></ul>
Name some non-infective differentials for a child wiith a fever for >5 days
<ul><li>Still's disease</li><li>Kawasaki disease</li><li>Rheumatic fever</li><li>Leukaemia</li></ul>
How is enthesitis diagnosed?
<ul><li>MRI scan-cannot differentiate cause thoguh</li></ul>
Name some complications of juvenile idiopathic arthritis
<ul><li>Flexion fractures: PT and splinting</li><li>Joint destruction: may need prosthesis</li><li>Growth failure: chronic disease and steroid use</li><li>Anterior uveitis: visual impairment</li></ul>
How is torticollis diagnosed?
<ul><li>Clinically history and exam-distinguish mechanical vs neuropathic pain</li></ul>
Name some differential diagnoses for torticollis
<ul><li>Acute disc prolapse</li><li>Tonsillitis</li><li>Cervical lymphadenopathy</li><li>C spine injury</li><li>Neurological disorders leading to dystonia</li></ul>
Name some redf lag symoptoms in a patient with likely torticollis
<ul><li>Neurological symptoms/signs</li><li>Malaise, fever, weight loss, unremitting pain affecting sleep</li><li>Hx of violent trauma, neck surgery or risk factors for osteoporosis</li></ul>
Name some risk factors for adolescent idiopathic arthritis
<ul><li>Positive family history</li><li>Peak adolescent growth spurt</li></ul>
How is scoliosis diagnosed?
<ul><li>Clincal exam</li><li>Standing x-rays</li><li>MRI considered</li></ul>
How is discoid meniscus diagnosed?
<ul><li>MRI </li></ul>
Name one risk factor for AML
<ul><li>Ionising radiation</li></ul>
Name some poor progmostic factors for AML
<ul><li>>60 years</li><li>>20% blasts after course of chemo</li><li>Cytogenetics: deletions of chromosome 5 or 7</li></ul>
How is AML diagnosed?
<ul><li>Bloods: leukocystosis</li><li>Blood film: blast cells</li><li>Bone marrow biopsy: Auer rods</li></ul>
How is AML treated?
<ul><li>Chemo and targeted therapy</li><li>Radiotherapy</li><li>Bone marrow transplant</li><li>Surgery</li></ul>
Name some complications of chemotherapy
<ul><li>Failure to treat caancer</li><li>Stunted growth and developmetn in children</li><li>Infections</li><li>Neurotoxicity</li><li>Infertility</li><li>Secondary malignancy</li><li>Cardiotoxicity</li><li>Tumour lysis syndrome</li></ul>
Name 3 non-blanching lesions and how to differentiate between them
<ul><li>Petechiae: <3mm-caused by burst capillaries</li><li>Purpura: 3-10mm</li><li>Ecchymosis: >10mm</li></ul>
Name some differentials for a non-blanching rash
<ul><li>Leukaemia</li><li>Meningococcal scepticaemia</li><li>Vasculitis</li><li>HSP</li><li>ITP</li><li>TTP</li><li>Traumatic or mechanical(e.g. severe vomiting)</li><li>Non-accidental injury</li></ul>
How can CML present?
<ul><li>Systemic: weight looss, tiredness, fever, night sweats</li><li>Splenomegaly</li><li>Bleeding</li><li>Gout</li><li>Hyperleukocytosis: visual disturbance, confusion, priapism, deafness</li></ul>
How is CML diagnosed?
<ul><li>Bloods: leukocytosis (particularly raised myeloid cells), anaemia</li><li>Bone marrow testing</li><li>Geneitcs: Philadelphia chromosome</li></ul>
How is ALL diagnosed?
<ul><li>Leukocytosis on FBC</li><li>Blood film and bone marrow: blast cells</li><li>Immunophenotyping: differentiate if origin is B or T cell</li></ul>
Name some poor prognostic factors for ALL
<ul><li>Age <1yr or >10 years</li><li>WCC: >20*10^9</li><li>CNS disease</li><li>Non-caucasian</li><li>Male</li></ul>
How is CLL diagnosed?
<ul><li>Blood: lymphocytosis, aanaemia, thrombocytopenia</li><li>Blood film: Smudge cells(ruptured WBC's)</li><li>Immunophenotyping: CD5,19,20,23</li></ul>
Name some complications of CLL
<ul><li>Richter's transformation</li><li>Anaemia</li><li>Hypogamaglobulinaemia-> recurrent infections</li><li>Warm AI heamolytic anaemia</li></ul>
Give aan example of a genetic condition that can predispose a chidl to brain tumours
<ul><li>Neurofibromatosis</li></ul>
Name some differential diagnoses for a paediatric brain tumour
<ul><li>Migraine</li><li>Intracranial hypertension</li><li>Epilepsy</li><li>Meningitis</li></ul>
How is a medulloblastoma treated?
<ul><li>Surgical resection and chemo</li></ul>
Name some differential diagnoses for pyloric stenosis
<ul><li>Gastroenteritis</li><li>GERD</li><li>Infantile colic</li></ul>
Name a differential diagnosis for mesenteric adenitis
<ul><li>Appendicitis</li></ul>
<div>-Higher grade fever</div>
<div>-Loss of appetite</div>
<div>-Nausea and vomiting</div>
<div>-Elevated WCC</div>
<div>-Focal pain in RLQ</div>
How is mesenteric adenitis managed?
<ul><li>Usually self limiting-observation and reassurance</li><li>Careful safety netting</li><li>Surgical: not usually advised, amy be needed if appendicitis can't definitively be ruled out</li></ul>
Name some differential diangoses for an i<span>ntussusception</span>
<ul><li>Gastroenteritis</li><li>Appendicitis</li><li>Volvulus</li><li>Meckel's diverticulum</li></ul>
How is i<span>ntussusception diagnosed?</span>
<ul><li>Abdominal USS: 'target sign'</li><li>Can reveal complications </li></ul>
How does intestinal malrotation present?
<ul><li>Bilious vomiting, often on the first day of life(with volvulus)</li></ul>
Name some differentials for a patient wtih intestinal malrotation
<ul><li>GERD</li><li>Pyloric stenosis</li><li>Duodenal atresia</li><li>Intestinal obstruction</li></ul>
How is malrotation diagnosed?
<ul><li>Upper GI contrast study-reveals obstruction point as no contrast will be able to pass</li><li>USS</li><li>Proximal bowel: corckscrew appearance</li></ul>
How is intestinal malrotation managed?
<ul><li>Laparotomy</li><li>If volvulus present: Ladd's procedure(includes division of Ladd bands and widening of base of mesentery</li><li>Relieve obstruction and correct congenital abnormality<br></br></li></ul>
Name some risk factors for GORD
<ul><li>Preterm delivery</li><li>Neurological disorders</li></ul>
Name some red flag symptoms in a child with suspected GORD
<ul><li>Not keeping down feed(pylroic stenosis/obstruciton)</li><li>Projectile vomiting</li><li>Haematemesis</li><li>Abdominal sdistention</li><li>Reduced consciousness, bulging fontanelle or neuro signs</li><li>Signs of infection</li><li>Rash, angioedema, allergic signs</li><li>Respiratory symptoms including apneoas</li></ul>
Name some complications for GORD
<ul><li>Distress</li><li>Failure to thrive</li><li>Aspiraiton</li><li>Frequent otitis media</li><li>Older children: dental erosion</li></ul>
If severe complicaiotns and medical treatment is ineffective, what might be considered for a patient with GORD?
<ul><li>Fundoplication</li></ul>
Describe what might be found on examination of a patient with appendicitis
<ul><li>Systemic: pyrexia and tachycardia</li><li>Localised tenderness and guarding in RIF</li><li>Tenderness over McBurney's point(1/3 frmo ASIS to umbilicus)</li><li>Rovsing's sign: RIF pain with palpation of left iliac fossa</li></ul>
<div><br></br></div>
<div>Also psoas or obturator sign</div>
Name some complications of appendicitis
<ul><li>Local abscess formation</li><li>Perforation</li><li>Gangrene</li><li>Postoperative wound infection</li><li>Peritonitis</li></ul>
How does appendicitis often present in patients under 4 years olf
<ul><li>More likely to be atypical and present with perforation</li></ul>
Name some complications of biliary atresia?
<ul><li>Unsuccessful anastamosis</li><li>Progressive liver diease</li><li>Cirrhosis with HCC</li></ul>
Name some differentials for a febrile convulsion
<ul><li>Meningitis</li><li>Encephalitis</li><li>Electrolyte imbalances causin seizures</li><li>Epilepsy</li></ul>
How are febrile convulsions managed?
<ul><li>If first seizure: admit </li><li>Source of fever identified and treated if necessary</li><li>Parental educations: appropriate use of antipyretics, don't ponge child to cool down</li><li>Phone ambulance in future if seizure lasts >5 mintues</li><li>If recurrent: benzos may be cnsidered-only on advice of specialist(rectal diazepam or buccal midazolam</li></ul>
Name some causes of encopresis
<ul><li>Spina bifida</li><li>Hirschprung's</li><li>Cerebral palsy</li><li>Learning disability</li></ul>
How might children with constipation present?
<ul><li><3 stools/week</li><li>Hard stool that are difficult to pass</li><li>Rabbit dropping stools</li><li>Abdominal pain</li><li>Straining resulting in rectal bleeding</li><li>Overflow diarrhoea</li></ul>
Name some red flags for constipation in children
<ul><li>Not passing meconium within 48hrs of brith(CF/hisrschprung's)</li><li>Neuro signs</li><li>Ribbon stool</li><li>Vomiting</li><li>Abnormal anus/lower back/buttocks</li><li>FTT</li><li>Acute severe abdo pain and bloating</li></ul>
Name some complicaitons of constipation in children
<ul><li>Pain</li><li>Decreased sensation</li><li>Anal fissures</li><li>Haemorrhoids</li><li>Overflow soiling</li><li>Psychosocial morbidity</li></ul>
Name some risk factors for developing cerebral palsy
<ul><li>Preterm birth</li><li>Low birth weight</li><li>Multiple birth</li><li>Congenital malformations</li></ul>
Name some causes of cerebral palsy
<div>Antenatal:</div>
<ul><li>cerebral malformation</li><li>congenital infection(rubells, toxoplamsosis, CMV), </li><li>maternal alcohol/smoking use<br></br></li><li>Maternal thrombotic disorders(factor 5 leiden)</li></ul>
<div>Intrapartum:</div>
<div><ul><li>Birth asphyxia</li><li>Trauma</li></ul><div>Postnatal:</div></div>
<div><ul><li>Intraventricular haemorrhage</li><li>Meningitis</li><li>Head trauma</li><li>Hypoglycaemia</li><li>Neonatal sepsis and encephalopathy</li></ul></div>
Name some general symptoms of cerebral palsy
<ul><li>Wide variety-delays in reaching developmental milestones, altered tone and weakness</li><li>Hand dominance before 18 months</li><li>Feeding diffuclties</li><li>Abdnormal gait</li></ul>
Name some associated non-motor symptoms of cerebral palsy
<ul><li>Learning difficulties</li><li>Epilepsy</li><li>Squints</li><li>Hearing impairment</li><li>GORD</li></ul>
Name some differentials for cerebral palsy
<ul><li>Muscular dystrophies</li><li>Metabolic disorders</li><li>Hereditary spastic paraplegia</li><li>JIA</li></ul>
Name some complications of cerebral palsy
<ul><li>Recurrent chest infections->aspiration pneumonias from feeding difficulties</li><li>Chornic constipation/incontinence</li><li>Visual/hearing impairment</li><li>Epilepsy</li><li>Behavioural and emotional difficulties</li><li>Contractions</li><li>GERD</li></ul>
Name some differentials for haemolytic disease of the newborn
<ul><li>Spherocytosis</li><li>G6PD deficiency</li><li>Thalassaemia</li></ul>
Howw is haemolytic disease of the newborn managed?
<ul><li>Intrauterine transfusions if severe anaemia detected in fetus</li><li>Early delivery if severe</li><li>Postnatal: phototherapy, exchange transfusion to manage high bilirubin</li><li>Immunoglobulin administration to newborn to prevent further haemolysis</li><li>Regular follow up to assess for developmetnal issues</li></ul>
Name some complications of haemolytic disease of the newborn
Unborn:<br></br><ul><li>Fetal heart failure</li><li>Fetal hydrops: fluid retention and swelling</li><li>Stillbirth</li></ul><div>Newborn:</div><div><ul><li>Kernicterus-> hearing loss, blindness, vision loss, brain damage, learning difficulties, death</li></ul></div>
Name a complication of a cephalohaematoma
<ul><li>Jaundice</li></ul>
How should chest compressions be carried out in children?
<ul><li>100-120/min for children and infants</li><li>Depth: at least 1/3 depth of chest(4cm infant, 5cm for child)</li><li>Children: lower half of sternum</li><li>Infants: 2 thumb encircling technique/2 fingers from one hand</li></ul>
Name some causes of acute respiratory distress syndrome
<ul><li>Infection: sepsis, pneumonia</li><li>Major trauma</li><li>Aspiration</li><li>Pancreatitis</li><li>Fat embolism</li><li>Drowning</li><li>Burns</li><li>DIC</li><li>Transfusion reactions</li></ul>
Name some differentials for acute respiratory distress syndrome
<ul><li>Cardiogenic pulmonary oedema</li><li>Covid</li><li>Bilateral penumonia</li><li>Diffuse alveolar haemorrhage</li></ul>
How is acute respiratory distress syndrome diagnosed/investigated?
<ul><li>CXR: bilateral alveolar infiltrates without other features of heart failure</li><li>Arterial blood gases: severity of hypoxaemia</li></ul>
<div>Others;</div>
<div><ul><li>Resp viral swab</li><li>Sputum, blood and urine cultures</li><li>Serum amylase: screen for pancreatitis</li><li>CT cehst</li></ul></div>
Name some differentials for neonatal respiratory distress syndrome
<ul><li>Transient tachypnoea of the newborn</li><li>Meconium aspiraiton syndrome</li><li>Pneumonia</li></ul>
How is neonatal respiratory distress syndrome diagnosed/investigated?
<ul><li>Usually clinical</li><li>CXR: 'ground glass appearance'</li><li>Blood gas: hypoxaemia and hypercapnia</li></ul>
How can the risk of neonatal respiratory distress syndrome be reduced in premature infants?
<ul><li>Administer glucocorticoids to mother before delivery to enhance surfactant production in the infant</li></ul>
Name some complications of neonatal respiratory distress syndrome
<ul><li>R->L shunt through collapsed lung or ductus arteriosus</li><li>Ventilator use complicaitons-> pneumonia, pneumothorax</li><li>Pulmonary/intracranial haemorrhage</li><li>Necrotising enterocolitis</li><li>Bronchopulmoanry dysplasia</li><li>Retinopathy of prematurity</li><li>Hearing and other neurological impairments</li></ul>
Name some neonatal risk factors for neonatal sepsis
<ul><li>Late pre-term</li><li>Low birth weight <2.5kg</li><li>Black race independent risk factor for Group B strep relateed sepsis</li></ul>
How do patients with neonatal sepsis present?
<ul><li>Respiratory distress: grunting, nasal flaring, tachypnoea</li><li>Feeding problems</li><li>Jaundice</li><li>Shock and multi-organ failure</li><li>Temperature: not a reliable sign, especiallly in pre-term infants(more likely to be hypothermic)</li><li>Seizures</li><li>Neurological sx</li><li>Discharge from eyes-> chlamydia or gonorrhoea</li><li>Periumbilical cellulitis</li><li>Meningitis: bulging fontanelle, seizures</li></ul>
How is neonatal sepsis diagnosed/investigated?
<ul><li>Cultures, FBC, CRP</li><li>Blood gases</li><li>Urine mc+s if late onset sepsis</li><li>LP especially if meningitis concern</li><li>CXR advised against unless strong suspicion of chest source</li></ul>
In a patient with neonatal sepsis, if concerned about meningitis what antibiotic might you consider adding?
<ul><li>IV cefotaxime annd IV gentamicin</li></ul>
In a patient with neonatal sepsis, if concerned about necrotising enterocolitis what antibiotic might you consider adding?
<ul><li>Add metronidazole for anaerobic cover</li></ul>
In a patient with neonatal sepsis, if the mother has chorioamnionitis what antibiotic might you consider adding?
<ul><li>IV amoxicillin and IV gentamicin to cover for listeria</li></ul>
How is transient tachypnoea of the newborn diagnosed/investigated?
<ul><li>Clinical</li><li>CXR: hyperinflation of lungs and fluid in horizontal fissure</li></ul>
How is meconium aspiration syndrome diagnosed/investigated?
<ul><li>Mostly clinical</li><li>CXR: patchy areas of atelectasis and hyperinflation</li><li>ABG</li><li>Monitoring of oxygen</li><li>CRP, cultures if infection suspected</li></ul>
Name some causes of persistent/severe neonatal hypoglycaemia
<ul><li>Preterm birth (<37weeks)</li><li>Materal diabetes</li><li>IUGR</li><li>Hypothermia</li><li>Sepsis</li><li>Inborn errors of metabolism</li><li>Nesidioblastosis</li><li>Beckwith-Wiedemann syndrome</li></ul>
How is gastroschisis investigated/diagnosed?
<ul><li>Intrauterine USS, MRI</li><li>Labs: increased maternal serum alpha fetoprotein</li></ul>
Name some risk factors for gastroschisis
<ul><li>Mother's young age</li><li>Exposure to alcohol/tobacco</li></ul>
Name some ocmplicaitons of gastroschisis
<ul><li>Intestinal inflammaiton for intrauterine exposure to amniotic fluid</li><li>Malabsorption</li><li>Infarction of intestinal tube due to compressed blood vessels</li><li>Infection</li></ul>
Name some conditions associated with exomphalos
<ul><li>Down's syndrome</li><li>Edward's</li><li>Patau's</li><li>Beckwith-Wiedemann syndrome</li></ul>
Name some risk factors for exomphalos
<ul><li>Alcohol/tobacco use in pregnancy</li><li>SSRIs</li><li>Ovesity</li></ul>
Name some complications of exomphalos
<ul><li>Abdominal cavity malformation</li><li>Volvulus</li><li>Ischaemic bowel</li></ul>
How is exomphalos diagnosed/investigated?
<ul><li>Intrauterine USS</li><li>MRI</li><li>Bloods: MSAFP</li><li>Amniocentesis</li></ul>
How does a staged surgical repair work for exomphalos treatment?
<ul><li>Sac allowed to granulate and peithelialise over weeks/months-> forms shell</li><li>As infant grows-> sac contents can fit inside</li><li>Shell removed and abdomen closed</li></ul>
Name some complications of intestinal atresia
<ul><li>Distention of stomach and duodenum-> accumulated fluid</li><li>Polyhydramnios(fetus swallows less fluid so more builds up)</li><li>Intestinal perforation</li><li>Meconium peritonitis</li></ul>
Name some of the signs/symptoms of intestinal atresia
<ul><li>Polyhdramnios antenatally</li><li>Postnatal: distended abdomen and vomiting</li><li>Vomiting may be bilious or non-bilious depending on site of atresia<br></br></li><li><br></br></li></ul>
How is duodenal atresia diagnosed/investigated?
<ul><li>Prenatal USS-> detectable in 3rd trimester: dilated fluid-filled stomach adjacent to dilated duodenum</li><li>Postnalat XR: double bubble sign</li><li>Physical exam in surgery: apple peel shape of intestines</li><li>Amniocentesis for Down's</li></ul>
<div><img></img>Double bubble sign<br></br></div>
Describe the treatment of duodenal atresia
<ul><li>Gastric decompression-> remove fluid from stomach</li><li>IV fluid compensation</li><li>Surgical reattachment of functional portions f intestines-> duodenoduodenostomy</li></ul>
Name some differentials for oesophageal atresia and tracheo-oesophageal fistula
<ul><li>Congenital diaphragmatic hernia</li><li>Duodenal atresia</li><li>GORD</li></ul>
How is oesophageal atresia diagnosed/investigated?
<ul><li>USS antenatally</li><li>CXR: coilde NG tube</li><li>Echo and renal USS to chekcl for associateed anomalies</li><li>Genetics if needed</li></ul>
Name some complications of oesophageal atresia and tracheo-oesophageal fistula
<ul><li>Anastomotic leak or stricture</li><li>Poor feeding and failure to thrive</li><li>Reccurence of tracheo-oesophageal fistual</li><li>Trachemoalacia</li><li>Recurrent chest infections and bronchiectasis</li><li>GORD</li></ul>
Name some differentials for necrotising enterocilitis
<ul><li>Sepsis</li><li>Gastroenteritis</li><li>Intestinal malrotation with volvulus</li><li>Hirschsprung's disease</li></ul>
How is necrotising enterocilitis investigaed/diagnosed?
<ul><li>Abdo X-ray</li><li>Abdo USS and venous blood gas may also be used</li></ul>
Name some preventative strategies for necrotising enterocilitis
<ul><li>Encourage breastfeeding in mothers of prem babies</li><li>Delayed cord clamping</li><li>Antenatal steroids in pre term labour</li><li>Treatment of preterm infants with caffeine citrate to prevent bronchopulmonary dysplasia</li></ul>
Name some complications of necrotising enterocilitis
<ul><li>Perforation and peritonitis</li><li>Short bowel syndrome</li><li>Sepsis and shock</li><li>DIC</li><li>Abscess formation</li></ul>
How are congenital diaphragmatic hernias diagnosed/investigated?
<ul><li>USS in utero</li><li>CXR/USS in neonate</li><li>Check for other abnormalities including genetics</li></ul>
How should bilirubin levels be measures in a neonate?
<ul><li>Transcutaenous first</li><li>If elevated serum bilirubin</li></ul>
Name some complication of neonatal jaundice
<ul><li>Related to phototherapy-> loose stools and dehydraiton</li><li>Kernicterus</li></ul>
Name some complications of kernicterus
<ul><li>Damage ot nervous system is permanent</li><li>Cerebral palsy</li><li>Learning difficulties</li><li>Deafness</li></ul>
Name some complicatons of TORCH infecitons
<ul><li>Pre term birth</li><li>Delayed devlopment(IUGR)</li><li>Physical malformations</li><li>Loss of pregnancy</li></ul>
How are TORCH infections transmitted?
<ul><li>To fetus through placenta</li><li>During birth from birth canal</li><li>Through breast milk</li></ul>
Name some general symptoms of TORCH infections
<ul><li>Fever</li><li>Lethargy</li><li>Cataracts</li><li>Jaundice</li><li>Reddish-brown spots on skin</li><li>Hepatosplenomegaly</li><li>Congenital heart disease</li><li>Microcephaly</li><li>Low birth weight</li><li>Hearing loss</li><li>Blueberry muffin rash</li></ul>
How is CMV transmitted?
<ul><li>Direct contact with infected bodily fluids: saliva, tears, mucus, semen and vaginal fluids</li></ul>
How is HSV1 transmitted?
<ul><li>Oral herpes: oral secretions: kissing, sharing utensils, sharing drinks</li></ul>
How is HSV 2 transmitted?
<ul><li>STD</li></ul>
How is HSV transmitted to a newborn?
<ul><li>Passage through the birth canal</li></ul>
Name a consequence of parvovirus B19 in pregnancy
<ul><li>Severe reduction in RBC-anaemia in infected newborn</li></ul>
How might newborns with HIV present?
<ul><li>Low birth weight</li><li>Hepatosplenomegaly</li><li>Recurrent bacterial infections-> meningitis and pneumonia</li></ul>
How are TORCH infections diagnosed?
<ul><li>Prenatal pCR from amniotic fluid: toxoplasmosis, syphilis, B19</li><li>CMV: viral culture, IgM, PCR</li><li>Rubella: IgM</li><li>HSV: viral infections, PCR</li></ul>
How is toxoplasmosis treated in pregnancy and infancy?
<ul><li>Pregnancy: spiramycin</li><li>Infants: pyrimethamine and sulfadiazine</li></ul>
How are VZV and HSV treated in pregnancy/neonatology?
<ul><li>Acyclovir</li></ul>
How is treponema pallidum treated in neonates?
<ul><li>Penicillin</li></ul>
How is listeriosis investigated/diagnosed?
<ul><li>Blood cultures, CSF cultures</li><li>Placental or meconium cultures in neonates</li></ul>
How is listeriosis prevented in pregnancy
<ul><li>Avoid potentially contaminated food products</li><li>Cultures if unexplained febrile illness or suspicion of infection</li></ul>
How might HSV in neonates be diagnosed/investigated?
<ul><li>PCR, virus culture, direct fluorescent testing</li><li>MRI brain if suspected encepahlitis</li></ul>
How can the risk of bronchopulmonary dysplasia be reduced during pregnancy
<ul><li>GAive corticosteroids-betamethasone for premature labour to help speed up lung development</li></ul>
How can the risk of bronchopulmonary dysplasia be reduced once born?
<ul><li>Use CPAP instead of intubation/ventilation</li><li>Caffeine to stimulate resiratory effort</li><li>Don't over-oxygenate </li></ul>
How is bronchopulmonary dysplasia diagnosed?
<ul><li>CXR and oxygen dependency of infant</li><li>Ssleep study to assess o2 satsa</li></ul>
Name some causes of epilepsy in children
<ul><li>Head trauma</li><li>Tumours</li><li>Infectious diseases</li><li>Prenatal injuries</li><li>Electrolye disturbances</li><li>Developmental disorders</li><li>Metabolic disorders</li></ul>
How is epilepsy diagnosed/investigated in children?
<ul><li>Refer urgently(<2weeks) for paeds assessment after 1st seizure</li><li>EEG-doesn't exclude epilpesy</li><li>MRI/CT to rule our structural causes</li><li>ECG for cardiacc causes</li><li>Genome sequencing if onset <2yrs and other features: learnign diasbilites etc)</li></ul>
Name some complications of epilepsy in children
<ul><li>Mood disorders</li><li>Status epilepticus</li><li>Sudden unexpected death in epilepsy</li><li>Developmental delay/regression</li></ul>
How are absence seizures diagnosed?
<ul><li>EEG: 3Hz, generalized, symmetrical</li></ul>
How are absence seizures treated?
<ul><li>Ethosuzimide 1st line</li></ul>
How is West’s syndorme diagnosed?
<ul><li>EEG: hypsarrhythmia</li><li>ID underlying cause e.g. tuberous sclerosis, encephalitis etc</li></ul>
Describe the treatment of West’s syndrome
<ul><li>Prednisolone</li><li>Vigabatrin</li></ul>
How is Dravet’s syndrome diagnosed?
<ul><li>Genetic testing</li></ul>
Name some causes of global developmental delay
<ul><li>Down's</li><li>Fragile X</li><li>Rett's syndorme</li><li>Metabolic disorders</li><li>Prematurity</li></ul>
Name 2 red flags when it comes to development
<ul><li>Developmental arrest: initially normal, stops gianing further skills</li><li>Developmental regression</li></ul>
Name some behaviours that might prompt a referral for developmental delay
<ul><li>Doesn't smile at 10 weeks</li><li>Hand preference before 12 months</li><li>Can't sit unsupported at 12 months</li><li>Can't walk at 18 months</li></ul>
Name some causes of gross motor delay
<ul><li>CP</li><li>Ataxia</li><li>Myopathy and muscular dystrophy</li><li>Spina bifida</li><li>Visual impairment</li></ul>
Name some causes of fine motor delay
<ul><li>visual impariments(cataracts, retinoblastoma, ambylopia)</li><li>Dyspraxia</li><li>CP</li></ul>
Name some causes of social, emotional and behavioural delay
<ul><li>ASD</li><li>Neglect</li><li>Genetics: Down's etc</li><li>Hearing impairment</li></ul>
Name some causes of speech delay
<ul><li>Global delay-mc</li><li>hearing impairment</li><li>Chronic otitis media with effusion</li><li>Environment-lack of stimulus</li><li>ASD</li><li>Bilingual househols</li></ul>
Name some key gross motor milestones
<ul><li>6-8 months: sits without support</li><li>12-15 months: walks unsupported</li><li>2 yrs: runs</li><li>3-4 yrs: hops on one leg</li></ul>
Name some general fine motor and vision milestones
<ul><li>Newborn: fix and follow face/light </li><li>3 mths: reaches for object</li><li>6 mths: palmar grasp, passess objects between hands</li><li>9-12 months: pincer grip</li></ul>
Name some differentials for retinoblastoma
<ul><li>Congenital cataracts</li><li>TORCH infection</li><li>Congenital rubella-characteristic 'salt and pepper' appearance</li></ul>
How is retinoblastoma investigated/diagnosed?
<ul><li>Ophthalmic exam under general anaesthesia: dilated fundus exam and UDD B scan(mass-> characteristic)</li><li>MIR-> spread</li><li>LP/bone marrow biopsy-> if suspicion of extraocular invasion</li><li>Genetics</li></ul>
Name some conditionas associated with an increased risk of neroblastoma
<ul><li>Turner;s</li><li>Hirschsprung's</li><li>NF1</li><li>Congenital central hypoventilation syndrome</li></ul>
How is neuroblastoma diagnosed/investigated?
<ul><li>Urine catecholamines-> sensitive and specific: high levels of vanillymandelic acid(noradrenaline breakdown product) and homovanillic acid(adrenaline)</li><li>Bloods: pancytopenia, serum catecholamines, LFT's, LDH</li><li>Imaging: abdo USS, if mass: CT/MRI abdomen</li><li>Bone scan</li><li>Biopsy</li></ul>
Name some differentials for neuroblastoma
<ul><li>Wilms' tumour</li><li>Rhabdomyosarcoma</li><li>Phaeochromocytoma</li><li>Other neural crest tumours</li></ul>
Name one condition associated with hepatoblastoma
<ul><li>Beckweth-Wiedemann syndrome</li></ul>
How is hepatoblastoma investigated/diagnosed?
<ul><li>AFP: tumour marker</li><li>CXR to check for spread</li><li>USS</li><li>CT/MRI for staging and metastasis</li><li>Biopsy</li></ul>
Name some differentials for osteosarcoma
<ul><li>Ewing sarcoma: elevated ESR and LDH</li><li>Chondrosarcoma</li><li>Lymphoma of bone</li></ul>
How is osteosarcoma investigated/diagnosed?
<ul><li>Urgent XR in 25 hrs if child/young person has unexplained bone swelling/pain-if positive x ray: 48 hour specialist assessmen</li><li>X-ray: new bony growth and periosteal reaction causing sunburnt appearance</li><li>Full body CT: metastasis</li><li>Definitive: biopsy</li></ul>
Name some poor prognostic factors for osteosarcoma
<ul><li>Primary metastasis</li><li>Axial/prominent extremity tumour site</li><li>Large tumoru volume</li><li>High serum ALP or LDH</li></ul>
How can Ewing’s sarcoma be classified?
<ul><li>Low grade restricted to hard coating of bone(A) or local tissues(B)</li><li>High grade tissue restricted to hard coating of bone (A) or extending to local tissues(B)</li><li>Low or high grade tumour whcih has metastasised</li></ul>
Name some differentials for Ewing’s sarcoma
<ul><li>Osteosarcoma</li><li>Osetomyelitis</li><li>Lymphoma</li></ul>
How is Ewing’s sarcoma diagnosed/investigated?
<ul><li>48 hr Xray if young person with unexplained bone swelling/pain-> 48 hr assessment if positive</li><li>Bloods: FBC and LDH</li><li>Xray: onion skin appearance of bone destruction with layers of periosteal bone formation</li><li>CT/MRI/PET</li><li>Bone biopsy</li></ul>
Name some poor prognostic factors for Ewing’s sarcoma
<ul><li>Large tumour burden</li><li>High lDH levels</li><li>Multiple bony metastasis</li><li>Axial localisation age >15yrs</li><li>Poor resposne to pre-op chemo</li></ul>
How is Hodgkin’s lymphoma diagnosed/investigated?
<ul><li>Normocytic anaemia, neutrophilia, thrombocytosis, eosinophilia</li><li>Raised ESR and LDH</li><li>Lymph node biopsy: Reed Sternberg cells cells-diagnostic</li><li>CT/PET to stage disease</li></ul>
Name some conditions associated with an increased risk of brain tumours
<ul><li>Neurofibromatosis</li><li>Li-Fraumeni syndrome</li><li>Familial adenomatous syndrome</li><li>Gorli syndrome</li></ul>
How are brain tumours in children diagnosed/investigated?
<ul><li>Any child with newly abnormal cerebellar or neurologic function URGENT referrla(<48hrs) for suspected brain cancer</li><li>MRI/CT to visualise space-occupying lesions</li><li>LP </li><li>Biopsy</li></ul>
Name some commplicaitons of paediatric brain tumours
<ul><li>GH deficiency</li><li>Cognitive decline</li><li>Subsequent brain tumour(risk increased duee ot radiotherapy)</li><li>Osteoporosis and poor mineral density</li></ul>
Name some differentials for von Willebrand’s disease
<ul><li>Haemophilia-> mc bleeding into joints and muscles</li></ul>
How is von Willebrand’s disease diagnosed/investigated?
<ul><li>Prolonged bleeding time and APTT</li><li>Normal PT and TT</li><li>Normal platelet count</li><li>Vin willebrand factor level and assay to confirm</li></ul>
Name some causes of microcytic anaemia in children
<ul><li>Iron deficiency-mc</li><li>Thalassaemia</li><li>Lead posioning</li></ul>
Name some causes of macrocytic anaemia in children
<ul><li>Vit B12/folate dficiency</li></ul>
Describe the treatment of IDA in children
<ul><li>Iron supplements+ diet advice</li><li>Vit B12 and folate if needed</li><li>Transfusions if severe</li><li>Tx underlying disease</li></ul>
How is alpha thalassaemia diagnosed/investigated?
<ul><li>FBC: microcytic anaemia</li><li>Hb electrophoresis-> can be normal, DNA analysis needed to make diagnosis</li></ul>
How is beta thalassaemia minor investigated/diagnosed?
<ul><li>Microcytosis with only mild anaemia</li><li>Blood filmd-target cells and basophilic stippling</li><li>Increased RBC</li><li>DIAGNOSTIC: Hb electrophoresis: raised HbA2</li><li>Ferritin normal/high</li></ul>
How is beta thalassaemia najor investigated/diagnosed?
<ul><li>Profound microcytic anaemia</li><li>Increased reticulocytes</li><li>Blood film: marked anisopoikilocytosis, target cells and nucelated RBCs</li><li>Methyl blue stains: RBC inclusions with precipitated alpha globin</li><li>Electrophoresis-> HbA2 and HbF raised</li><li>HbA2 normal or mildly elevated</li></ul>
Name some complications of beta thalassaemia major
<ul><li>Cardiomyopathy/arrhthymia/failure-AF in older patients</li><li>Acute bacterial sepsisrisk increased post splenectomy</li><li>liver cirrhosis, portal hypertension</li><li>Endocrine dysfunction: hypocalcaemia with tetany due to hypoparathyroidism</li><li>Iron overload</li><li>Death-> usually due to undiagnosed heart failure</li></ul>
How can iron overload be prevented?
<ul><li>Iron chelating agents: desferrioxamine/deferiprone/deferasirox</li></ul>
Name some differentials for sickle cell anaemia
<ul><li>Thalassaemia</li><li>G6PD deficiency</li><li>Haemoglobin C-variant which doesn't cause sx unlesss combined with HbS variant</li></ul>
How is sickle cell disease diagnosed/investigated
<ul><li>Diagnostic: Hb electrophoresis</li><li>CBC: anaemia</li><li>Blood smear: ID sickle shaped cells</li></ul>
How is fanconi anaemia diagnosed/investigated?
<ul><li>CBC, bone marrow</li><li>Chromosome DEB assay</li><li>Chromosomal breakage test positive</li><li>Cytometric flow analysis</li></ul>
How is fanconi anaemia treated?
<ul><li>Growth factors(G-CSF)</li><li>Androgen therapy</li><li>Transfusions</li><li>Stem cell transplant</li><li>Screen and monitor for malignancies</li><li>Family support, genetic counselling</li></ul>
Name some complications of fanconi anaemia
<ul><li>Neutropenia-> life-threatening infections</li><li>Malignancies: myelogenous leukaemias, myeloddysplastic syndromes etc</li><li>Endocirne derangements</li><li>Congenital anomalies</li></ul>
Name some differentials for haemophilia
<ul><li>Von Willebrand Disease</li><li>Factor deficiencies</li><li>Platelet disorders</li><li>Hamatological malignancies</li><li>Vasculitis</li></ul>
How is haemophilia investigated/diagnosed?
<ol><li>Prolonged APTT with normal bleeding time, PT and thrombine time</li><li>Diagnostic: factor 8/9 assay</li><li>vWF antigen normal</li></ol>
Name a complication of Haemophilia A
<ul><li>Up to 1/3 of boys with haemophilia A will develop antibodies to factor 8 tx: worsens bleeding and complicates therapy</li></ul>
Name some differentials for ITP
<ul><li>Aplastic anaemia</li><li>Leukaemia</li><li>TTP</li></ul>
How is ITP diagnosed/investigated?
<ul><li>FBC: isolated thrombocytopenia</li><li>Blood film</li><li>Inflammatory markers</li><li>Bone marrow biopsy-only done if atypical features</li></ul>
Name some complications of ITP in children
<ul><li>Significant bleeds(3%)</li><li>Intracranial haemorrhage(1/300)</li><li>Typically occur when plt counts <20 + have pre-existing vascular abnormalities</li></ul>
Name some causes of TTP
<ul><li>Post-infection: urinary, GI</li><li>Pregnancy</li><li>Drugs: ciclosporin, OCP, penicillin, clopidogrel, aciclovir</li><li>Tumours</li><li>SLE</li><li>HIV</li></ul>
How is TTP investigated/diagnosed?
<ul><li>Diagnostic: Low ADAMST13 activity</li><li>Urine dpistick: haematuria, non-nephrotic range proteinuria</li><li>FBC: normocytic anaemia, thrombocytopenia and raised neutrophil</li><li>U&E: raised urea and creatinine</li><li>Clotting normal</li><li>Blood film: reticulocytes(secondary to haemolysis) and schistocytes(fragmented RBCs)</li><li>D-dimer raised</li></ul>
Name some differentials for testicular torsion
<ul><li>Epididymo-orchitis</li><li>Trauma</li><li>Inguinal hernia</li></ul>
How is testicular torsion diagnosed/investigated?
<ul><li>Clinical</li><li>Doppler USS-> reduced/absent blood flow to affected testicle-'whirlpool' sign</li><li>Urinalysis: rule out infection/UTI</li><li><b>Shouldn't delay treatment to wait for investigations</b></li></ul>
Name some complications of testicular torsion
<ul><li>Testicular necrosis</li><li>Impaired fertility</li><li>Contralateral testicular torsion in 40% of cases without bilateral fixation</li></ul>
How does testicular torsion present in neonates?
<ul><li>Paainless scrotal swelling whcih does not transilluminate</li></ul>
Give some examples of primary sexual characteristics
<ul><li>Men: penis, scrotum, testes</li><li>Women: vulva, vagina uterus, ovaries</li></ul>
Give some examples of secondary sexual characteristics
<ul><li>Men: facial hair, testicle/penile enlargement</li><li>Women: Pubic hair, breast development, widening of hips</li></ul>
How can precocious puberty be classified?
<ul><li>Gonadotrophin-dependent precocious puberty(GDPP)</li><li>Gonadotrophin independent precocious puberty(GIPP)</li></ul>
Name some causes of gonadotrophin-dependent precocious puberty(GDPP)
<ul><li>Idiopathic(>90% of cases)</li><li>Brian tumours</li><li>Cranial radiotherapy</li><li>Structural brain damage: hydrocephalus, meningitis, traumatic head injury</li></ul>
Name some causes of gonadotrophin-independent precocious puberty
<ul><li>Gonadal tumours</li><li>Adrenal/liver tumours</li><li>Congenital adrenal hyperplasia</li></ul>
Name some differentials for precocious puberty
<ul><li>Thryoid disorders</li><li>Growth hormone excess(acromegaly etc0</li><li>McCue-Albright syndrome</li></ul>
How is precocious puberty diagnosed/investigated?
<ul><li>Measure oestradiol/testosterone levels, adrenal androgens, TFTs and HCG</li><li>Brain MRI</li><li>Pelvic USS-> ovarian cysts/pathology</li><li>Hand and wrist X-rays for bone age</li><li>Intra-abdominal imaging if adrenal/hepatic tumour suspected</li><li>MRI brain and GnRH stimulation test dependednt on initial investigation results</li></ul>
Name some complications of precocious puberty
<ul><li>Accelerated skeletal development and premature fusion of bone growth plates-> reduced final adult height</li><li>Psychological wellbeing</li></ul>
How do patients with Kallmann’s syndrome present?
<ul><li>Typical: <b>boy with delayed puberty and anosmia(no smell)</b></li><li>Hypogonadism, cryptorchidism</li><li>Low sex hormone levels</li><li>LFF/FSH low/normal</li><li>Normal/above-average height</li><li>Cleft lip/palate abd visual/hearing defects also seen in some patients </li></ul>
Name some differentials for congenital adrenal hyperplasia
<ul><li>Adrenocortical tumour</li><li>PCOS</li><li>Hypothyroidism</li><li>Addison's disease</li></ul>
How is congenital adrenal hyperplasia investigated/diagnosed?
<ul><li>Bloods: 17-hydroxyprogesterone and ACTH elevated in CAH+ cortisol low</li><li>ACTH stimulation testing: gold standard</li><li>Genetic testing-to ID specific enzyme too</li><li>Imaging: USS to assess internal organs if ambiguous genitalia</li><li>Not currently routinely screened for</li></ul>
Name some complications of congenital adrenal hyperplasia
<ul><li>Growth suppression(premature epiphyseal closure-> high concentration of sex steroids)</li><li>Metabolic syndrome(diabetes, obesity, htn)</li><li>Infertility</li></ul>
How is obesity defined in children?
<ul><li>BMI >98th centile for their age and sex</li><li>Overweight: >91st centile</li></ul>
Name some causes of obesity in children
<ul><li>Growth hormone deficiency</li><li>Endocrine: Hypothyroidism, Cushing's</li><li>Down's</li><li>Genetics: Prader-Willi</li><li>Medications: steroids</li></ul>
Name some consequences of obesity in childhood
<ul><li>Orthopaedic problems: SUFE,, blount's disease, MSK pain</li><li>Psychological consequences: poor self-steem, bullying</li><li>Sleep apnoea</li><li>Benign intracranial htn</li><li>Long term: Increased risk of T2DM, htn, ischaemic heart disease</li></ul>
Name some risk factors for congenital hypothyroidism
<ul><li>Medication use during pregnancy-e.g. carbimazole</li><li>Maternal advanced age</li><li>Fhx of thyroid disease</li><li>Low birth weight</li><li>Pre-term birth</li><li>Multiple pregnancies</li></ul>
Name some differentials for congenital hypothyroidism
<ul><li>Down's syndrome</li><li>Congenital metabolic disorders</li></ul>
How is congenital hypothyroidism diagnosed/investigated?
<ul><li>Newborn screening: TSH>20mU/L</li><li>Elevated TSH and decreased free T4</li><li>Imaging: Thyroid USS/radionuclide scan to ID thyroid dysgenesis</li><li>Hearing assessment</li></ul>
Name some complications of congenital hypothyroidism
<ul><li>Irreversible intellectual disability</li><li>Sx of hyperthyroidism due to over-replacement of levothyroxine: wt loss, heat intolerance, tachycardia, diarrhoea, palpitations</li></ul>
How is pica investigated/diagnosed?
<ul><li>FBC: check for anaemia</li><li>Iron studies</li><li>Serum zinc levels</li><li>Lead level</li><li>Abdo x-ray: ingested foreign objects or GI obstruction</li><li>USS/CT if obstruction/perforationn suspected</li><li>Psych evaluation</li></ul>
Name some complications of pica
<ul><li>Nutritional deficiencies</li><li>GI complications: obstruction, perforation, intestinal parasites</li><li>Dental problems</li><li>Toxicity: lead poisoning etc</li><li>Infections</li></ul>
Name a risk factor for eczema
<ul><li>Fhx of atopy(asthma, hayfever)</li></ul>
How can eczema be classified?
<ul><li>Atopic eczema</li><li>Allergic contact dermatitis</li><li>Irritant contact dermatitis</li><li>Seborrheic dermatitis</li><li>Venous eczema</li><li>Asteatotic dermatitis</li><li>Erythrodermic eczema</li><li>Pompholyx eczema</li></ul>
How is eczema diagnosed?
<ul><li>Usually clinical</li><li>Patch test: if allergic contact dermatitis</li><li>Swabs: if concerned about infection</li><li>Bloods: if concerned about infection-total IgE and raised eosiniphils </li></ul>
How can eczema be classified in order of severity
<ul><li>Mild: areas of dry skin and infrequent itching</li><li>Moderate: dry skin, frequent itching and erythema</li><li>Severe: widespread, incessant itching and erythema</li><li>Infected: weeping, crusted, pustules, fever or malaise</li></ul>
Name some complications of eczema
<ul><li>Scratching: poor sleep, poor mood, bacterial infection rik</li><li>Psycho-social: insecurities, avoid certain activities like swimming</li><li>Eczema herpeticum</li></ul>
How is eczema herpeticum diagnosed?
<ul><li>Swab and Tzanck test</li></ul>
How is eczema herpeticum treated?
<ul><li>IV aciclovir</li><li>Often given concomitantly with antibiotics as concomitant bacterial infection common and difficult to exclude clinically</li></ul>
Name some causes of Stevens Johnson syndrome
<ul><li>Beta lactams: penicillins and cephalosporins</li><li>Sulphonamides</li><li>Lamotrigine, carbamazepine, phenytoin</li><li>Allpurinol</li><li>NSAIDs</li><li>OCP</li><li>Infectious: HSV, EBV, influenza, hepatitis</li></ul>
Name some differentials for Steven-Johnson syndrome
<ul><li>Erythema multiforme</li><li>Drug rash with eosinophilia and systemic sx(DRESS)</li></ul>
How is Steven-Johnson syndrome diagnosed?
<ul><li>Usually clinical</li><li>Skkin biopsy-> necrotic keratinocytes and a sparse lymphocytic infiltrate</li></ul>
Name some differentials for allergic rhinitis
<ul><li>Sinusitis</li><li>Nasal polyps</li><li>Deviated nasal septum</li><li>Common cold</li></ul>
How is allergic rhinitis diagnosed?
<ul><li>Clinical</li><li>Skin prick or blood tests for specific IgE antibodies to ID allergen</li></ul>
Name some causes of rashes in children
<ul><li>Septicaemia</li><li>Slapped cheek</li><li>Hand foot and mouth</li><li>Measles</li><li>Urrticaria</li><li>Chickenpox</li><li>Roseola</li><li>Rubella</li></ul>
Name some differentials for urticaria
<ul><li>Dermatitis</li><li>Drug eruptions</li><li>Erythema multiforme</li><li>Vasculitis</li><li>AI disorders</li></ul>
How is urticaria diagnosed/investigated?
<ul><li>Clinical-thorough history and exam</li><li>Allergy testing</li><li>Bloods: FBC, LFT, TFT, ESR, CRP: rule out underlying systemic diseases</li><li>Urinalysis if suspected vasculitis</li><li>Skin biopsy</li><li>Sx diaries: establish triggers and timings</li></ul>
Name some complications of urticaria
<ul><li>Resp compromise in severe cases of angioedema involving upper airway</li><li>Psych distress and decreased QOL</li><li>SE's from long0term meds</li></ul>
Name some different kinds of birth marks
<ul><li>Salmon patches/stork-marks</li><li>Haemangiomas/strawberry marks</li><li>Port wine stains</li><li>Cafe-au-lait spots</li><li>Blue-grey spots</li><li>Congenital moles/naevi</li></ul>
How can anaphylaxis be investigated/diagnosed?
<ul><li>Serum mast cell tryptase: ppeak 1 hr post anaphylaxis, remain high for 6 hours</li><li>Shouldn't delay treatment</li></ul>
Name some investigations used to iagnose/assess rheumatic fever
<ul><li>ECH-prolonged PR</li><li>Bloods: FBC, CRP, ESR, cultures</li><li>Proof of recent strep infection</li><li>CXR-heart failure</li><li>Echo-valvular abnormalities</li></ul>
Name some complications of rheumatic fever
<ul><li>Mitral stenosis-isolated is mc</li><li>Mitral regurg</li><li>Mixed mitral stenosis and regurgitation</li><li>Aortic regurgitation</li><li>Aortic stennosis</li><li>Tricuspid regurg/stenosis</li></ul>
Name some differentials for paediatric heart failure
<ul><li>Asthma</li><li>Pneumonia</li><li>GORD</li><li>Anaemia</li></ul>
How can infective endocarditis be classified?
<ul><li>Acute: Up to 6 weeks</li><li>Subacute: 6 weeks-3 months</li><li>Chronic: >3 months</li></ul>
Name some non-infective causes of infective endocarditis
<ul><li>Marantic endocarditis(malignany-pancreatic cancer)</li><li>Libman-Sacks endocarditis(SLE)</li></ul>
Name some of the symptoms of infective endocarditis
<ul><li>Diverse and variable-can be rapid progression or chronically/non-specific</li><li>Fever-mc</li><li>Night sweats</li><li>Anorexia</li><li>Weight loss</li><li>Myalgia</li><li>Headache</li><li>Arthralgia</li><li>Abdo pain</li><li>Cough</li><li>Pleuritic pain</li></ul>
Name some differentials for infective endocarditis
<ul><li>Non-infectious endocarditis</li><li>Rheumatic fever</li></ul>
How is infective endocarditis diagnosed?
<ul><li>Modified Duke criteria</li><li>2 major OR one major and 3 minor OR all 5 minro</li></ul>
How can you remember the Duke criteria?
BE FIVE PM<br></br>Major:<br></br><ul><li>Blood cultures</li><li>Evidence of endocardial involvement on echo</li></ul><div>Minor:</div><div><ul><li>Fever</li><li>Immunological phenomena</li><li>Vascular phenomena</li><li>Echo</li><li>Predisposing features</li><li>Microbiological evidence</li></ul></div>
Name some indications for surgery in patients with infective endocarditis
<ul><li>Haemodynamic instability</li><li>Severe heart failure</li><li>Severe sepsis</li><li>Valve obstruction</li><li>infected prosthetic valve</li><li>Persistent bactaraemia</li><li>Repeated emboli</li><li><b>Aortic root abscess-> PR prolongation on ECG</b></li></ul>
Name some complications of infective endocarditis
<ul><li>Acute valvular insufficiency causing heart failure</li><li>Neurological sx: stroke, abscess, haemorrhage</li><li>Embolic complications-> infarctions of kidneys, spleen or lung</li><li>Inffections: osteomyelitis, septic arthritis</li></ul>
How is congenital heart block diagnosed?
<ul><li>Prenatal scans: fetal bradycardia</li><li>ECG: complete dissociation between P waves(atrial contraction) and QRS complexes(ventricular contraction)</li></ul>
Name some complications of congenital heart block
<ul><li>Fetal hydrops and intrauterine death</li><li>Heart failure</li></ul>
Name some red flag features when considering a diagnosis of IBS
<ul><li>Rectal bleeding</li><li>Unexplained/unintentional weight loss</li><li>Fhx of bowel or pvarian cancer</li><li>Onset after 60 years</li></ul>
Name some differentials for IBS
<ul><li>IBD</li><li>Coeliac</li><li>Colorectal cancer</li></ul>
Name some parasitic causes of gastroenteritis
<ul><li>Cryptosporidium</li><li>Entamoeba histlytica</li><li>Giardia intestinalis</li><li>Schistosoma</li></ul>
Name some differentials for gastroenteritis
<ul><li>Food poisoning</li><li>IBS</li><li>IBD</li><li>Peptic ulcer disease</li><li>Bowel obstruction</li></ul>
How is gastroenteritis diagnosed/investigates?
<ul><li>Clinical</li><li>BP</li><li>Stool cultures: if immunocompromied, recently travelled abroad, mucus/blood in stool</li><li>Urine dip for blood/protein: haemolytic uraemic syndrome</li><li>Bloods and blood cutures</li><li>Stool cultures if not improving after 7 days</li></ul>
How is gastroenteritis caused by salmonella/shigella treated?
<ul><li>Ciprofloxacin</li></ul>
How is gastroenteritis caused by campylobacter treated?
<ul><li>Macrolide like erythromycin</li></ul>
How is gastroenteritis caused by cholera treated?
<ul><li>Tetracycline</li></ul>
How should the spread of gastroenteritis be prevented?
<ul><li>Children off school until 48 hours after last episode of vomiting/diarrhoea</li><li>Shouldn't swim in swimmin gpools for 2 weeks after</li></ul>
Name some risk factors for developing dehydration in patients with gastroenteritis
<ul><li><1yr</li><li>Low brith weight/malnutrition</li><li>24 hours: >2 vomits or >5 diarrhoeal stools</li><li>Unable to tolerate fluids</li></ul>
Name some complications of gastroenteritis
<ul><li>Dehydration</li><li>Lactose intolerance following resolution of gastroenteritis episode</li><li>Haemolytic uraemic syndrome</li></ul>
Name some risk factors for Crohn’s disease
<ul><li>Family history</li><li>Smoking : 3 times increased risk</li><li>Diets high in refined carbs and fats</li></ul>
How is Crohn’s disease diagnosed?
<ul><li>Faecal calprotectin: raised</li><li>Colonoscopy with biopsy-diagnostic</li><li>Anaemia, raised ESR/CRP, thrombocytosis, haematinics and iron studies</li><li>Transmural inflammation seen on imaging(MRI)</li></ul>
Name some complications of Crohn’s disease
<ul><li>Fistulas</li><li>Strictures</li><li>Abscesses</li><li>Malabsorption</li><li>Perforation</li><li>Nutritional deficiencies</li><li>Increased risk of colon cancer</li><li>Osteoporosis</li><li><b>Intestinal obstruction and toxic megacolon</b></li></ul>
Name some differentials for Ulcerative colitis
<ul><li>Crohn's</li><li>Infectious colitis</li><li>Ischaemic colitis</li></ul>
How is Ulcerative colitis diagnosed/investigated?
<ul><li>Faecal calprotectin</li><li>Bloods: raised ESR/CRP, anaemia and raised WCC</li><li>Long standing UC: Lead pipe colon on abdo x ray</li><li>Colonosopy, barium energy and biopsy</li></ul>
Name some indications for urgeent surgery in a patient with Ulcerative colitis
<ul><li>Acute fulminant UC</li><li>Toxic megacolon with little improvement after 48-72 hours</li><li>Sx worsening despite IV steroids</li></ul>
Name some acute complications of Ulcerative colitis
<ul><li>Toxi megacolon</li><li>Massive lower GI haemorrhage</li></ul>
Name some long-term complications of Ulcerative colitis
<ul><li>Colorectal cancer</li><li>Cholangiocarcinoma</li><li>Colonic strictures-> large bowel obstruction</li></ul>
Name 3 things gluten is found in
<ul><li>Wheat</li><li>Rye</li><li>Barley</li></ul>
Name some risk factors for coeliac disease
<ul><li>Family history</li><li>HLA-DQ2 allele</li><li>Co-existing AI conditions</li></ul>
Name some differentials for coeliac disease
<ul><li>IBS</li><li>IBD</li><li>Lactose intolerance</li></ul>
How is coeliac disease diagnosed?
<ol><li>Anti TTG IgA antibody and total IgA levels, IgA EMA antibodies</li><li>GS: OGD with jejunal biopsy: subtotal villous atrophy</li></ol>
Name osme complications of coeliac disease
<ul><li>Anaemia(iron, B12 or folate deficiency)</li><li>Hyposplenism</li><li>Osteoporosis</li><li>Enteropathy associated T cell lymphoma(EATL)</li></ul>
How can undernutrition be classified?
<ul><li>Wasting-low weight for height</li><li>Stunting: low height for age</li><li>Underweight: low weight for age(can be due to stunting wasting or both)</li><li>Micronutrient-related malnutrition: iron, vitamin A or iodine</li></ul>
Name some differentials for malnutrition in children
<ul><li>Specific genetics: Prader-Willi/Turner</li><li>Infectious diseases</li><li>Coeliac</li></ul>
How might malnutrition be assessed in a child?
<ul><li>Accurate measurement of height and weight plotted on growth charts</li><li>Bloods to check for anaemia and specific deficiencies</li><li>Tests to check for specific organic causes</li></ul>
Name some complications of malnutrition
<ul><li>More frequent/severe infections</li><li>Poor wound healing</li><li>Failure to thrive</li><li>Reduced muscle mass</li><li>Poor bone health-rickets/osteoporosis</li><li>Reduced congition</li><li>Leading cause of mortality in children<5yrs globally</li></ul>
How can FTT be classified?
<ul><li>Organic-medical illness</li><li>Non-organic: psycho-social</li></ul>
Name some causes of organic FTT
<ul><li>GI: GERD, malabsorption like coeliac</li><li>Metabolic: thryoid disorders</li><li>Chronic: congenital heart disease, CF</li></ul>
Name some differentials for FTTQ
<ul><li>UTI-common</li><li>Laryngomalacia</li><li>Pyloric stenosis</li><li>CF</li></ul>
How should FTT be assessed/investigated?
<ul><li>Growth parameters-growht chart</li><li>Physical signs of malnutrition-muscle wasint, SC fat loss, brittle hair</li><li>Developmental assessment</li><li>Investigations for underlying dx: bloods, coeliac screen etc</li></ul>
How do patients with Hirschsprung’s disease present?
<ul><li>Neonatal: failure/delayed passage of meconium, vomiting</li><li>Older children: tx resistant constipation, abdominal distention, poor weight gain</li></ul>
How is Hirschsprung’s disease investigated/diagnosed?
<ul><li>Abdo x-ray</li><li><b>Rectal biopsy:</b> gold standard</li></ul>
Name some differentials for Meckel’s diverticulum
<ul><li>Gastroenteritis</li><li>Appendicitis</li><li>IBD</li><li>Intestinal obstruction</li></ul>
How is Meckel’s diverticulum investigated/diagnosed?
<ul><li>Technetium-99m scan-ID ectopic gastric mucose(if stable)</li><li>CT can show intususseption</li><li>Ix should not delay tx-dx can be made operatively</li></ul>
Name some features indication a Meckel’s diverticulum is high risk
<ul><li>Longer than 2cm or narrow neck/fibrotic tissue</li><li>Ectopic gastric tissue</li><li>Inflamed diverticulum</li></ul>
Name some complications for Meckel’s diverticulum
<ul><li>Haemorrhage</li><li>Intussusception</li><li>Obstruction</li><li>Ulceration and perforation</li></ul>
Describe the symtpoms of toddler’s diarrhoea
<ul><li>Stools vary in consistency</li><li>Often contain undigested food</li><li>>3 loose stools per day</li></ul>
How can cow’s milk protein intolerance be classified?
<ul><li>Immediate: IgE mediation: CMPA(allergy)</li><li>Delayed: non-IgE mediated(CMPI(intolerance)</li></ul>
How is cow’s milk protein intolerance diagnosed/investigated?
<ul><li>Eliminate cow's milk protein from diet for 2-6 weeks and reintroduce-monitor symptoms</li><li>Skin prick test</li><li>Specific IgE testing</li></ul>
Name some differentials for cow’s milk protein intolerance
<ul><li>Lactose intolerance</li><li>GERD</li><li>Eosinophilic oesophagitis</li></ul>
How is a choledochal cyst diagnosed?
<ul><li>Abdo USS scan-> dilated bile duct</li><li>MRCP/ERCP</li></ul>
How is a choledochal cyst treated?
<ul><li>Surgical removal of cyst and gallbaldder</li><li>Liver biopsy at same time to check for damage</li></ul>
Name some complications of a choledochal cyst
<ul><li>Liver fibrosis/cirrhosis</li><li>Cholangitis</li><li>Pancreatitis</li><li>Cancer of bile ducts</li></ul>
Name some complications of neonatal hepatitis
<ul><li>If untreated for >6 months risk of chronic liver disease-> hepatic cirrhosis-> liver failure</li></ul>
How is neonatal hepatitis investigated/diagnosed?
<ul><li>USS: check bile ducts for obstruction and correct development</li><li>Liver biopsy: multinucelated giant cells</li><li>Bloods: high serum bilirubin</li></ul>
How can hernias be classified?
<ul><li>Location of hernia</li><li>Status of bowel</li></ul>
Describe the types of hernias when classed by location
<ul><li>Umbilical</li><li>Epigastric</li><li>Inguinal</li></ul>
How are strangulated hernias investigated/diagnosed?
<ul><li>Clinically when reducible</li><li>USS typically first line-rule out causes of acute abdomen</li><li>CT for signs of ischaemia</li><li>Bloods ofr signs of infection</li></ul>
Name some complications of a hernia
<ul><li>Recurrence of hernia</li><li>Stranguled-> bowel ischaemia, necrosis , perforation and sepsis</li></ul>
