31.5.2013(pediatrics) 23 Flashcards by rakesh durai

False negative mantoux

Milliary TB
TB meningitis
Malnutrition

How well did you know this?

Not at all

Perfectly

Expected height

6x+77

How well did you know this?

Not at all

Perfectly

Bloody diarrhoea
Renal stones
Mildly positive mantoux
Normal sigmoidoscopy

Crohn

How well did you know this?

Not at all

Perfectly

Risk of bowel malignancy in IBD

Equal in both Crohn and UC!

How well did you know this?

Not at all

Perfectly

Type of arthritis in IBD

Peripheral arthritis

How well did you know this?

Not at all

Perfectly

Most specific skin manifestation of UC

Pyoderma gangrenosum

How well did you know this?

Not at all

Perfectly

Colectomy in IBD

Reverses extraintestinal manifestations

How well did you know this?

Not at all

Perfectly

Test used to diagnose CHO malabsorption

urinary d-Xylose test

How well did you know this?

Not at all

Perfectly

Commonest cause of PHT in children

Extrahepatic cause

How well did you know this?

Not at all

Perfectly

Diff btw intra and extra heptic causes for PHT

Extrahepatic
No jaundice
Mild ascites
No dilated veins over anterior abdominal wall
No family history
Presenting complaint- bleeding
Splenomegaly with normal liver(hard liver in Intrahepatic cause)

How well did you know this?

Not at all

Perfectly

Commonest cause of Extrahepatic PV obstruction in children

Portal vein thrombosis

Non visualisation of portal vein

How well did you know this?

Not at all

Perfectly

Causes for portal vein thrombosis

Intraabdominal sepsis
Thrombophilia
H/o umbilical artery/umbilical vein catheterisation(commonest)
Severe dehydration

How well did you know this?

Not at all

Perfectly

Presinusoidal Extrahepatic cause of PHT

Non cirrhotic portal fibrosis
Congenital hepatic fibrosis
Myeloproliferative disease
LHC histiocytosis

How well did you know this?

Not at all

Perfectly

Severity of extraintestinal manifestations of IBD

Correlates with activity of disease

How well did you know this?

Not at all

Perfectly

Commonest cause of gallstones in children

Pigment stones

Hereditary spherocytosis(most common cause)

How well did you know this?

Not at all

Perfectly

Childhood cholelithiasis

Pigment stones

Haemolytic Anemia(HS>SS>thal)
Wilson
Cirrhosis,cholestasis
Sick premature babies
TPN

How well did you know this?

Not at all

Perfectly

Causes of cholesterol stones in children

Bile salt malabsorption(illeal disease,CF)
Cilliary dyskinesia
Obesity

How well did you know this?

Not at all

Perfectly

Mild unconjugated bilirubin with normal LFT no bleeding tendency

Gilbert disease

How well did you know this?

Not at all

Perfectly

Response to phenobarbitone present in

Gilbert

Criggler najjar type II(decreased SB in 25%)

How well did you know this?

Not at all

Perfectly

Colourless bile seen in

Criggler najjar type 1

How well did you know this?

Not at all

Perfectly

Congenital hyperbilirubinemia with abnormal histology

Dubin Johnson

How well did you know this?

Not at all

Perfectly

Aversion to smoking

Hepatitis A

How well did you know this?

Not at all

Perfectly

Direct hepatocyte injury is mechanism in

HepA and HepE

How well did you know this?

Not at all

Perfectly

Accelerated course of hepatitis B vaccine

0,1,2,12months

How well did you know this?

Not at all

Perfectly

Meningioma in olfactory groove

Anosmia Ipsilateral optic atrophy Contralateral papilledema Foster Kennedy syndrome

SB I Gilbert increases with

Starvation Stress Fever Alcohol

Mode of inheritance of Gilbert

Autosomal dominant

Gilbert syndrome cause

Reduction in UGT1A1 activity(reduced to 10-35%)+decreased hepatic clearance

Gilbert syndrome is common in

Males

Bilirubin levels in Gilbert

Mild,unconjugated hyperbilirubinemia <3mg%

Diagnosis of Gilbert

SB increases with test starvation for 48hrs | or IV nicotinic acid

Substance rarely deposited in Gilbert

Lipofuschin

LFT | Hepatic histology in Gilbert and CN

Normal

Bilirubin UDP glucuronyl transferase activity in Criggler najjar type 2

Reduced to 10% of normal

SB in CN type 1

>20mg%

Test abnormal in both DJ and Rotor

Bromsulphthalein test(test of hepatic excretory function)

Additional defect in ROTOR

Organic anion uptake defect

GB not visualised in which congenital conjugated hyperbilirubinemia

Dubin Johnson

Normal urine coproporphyrin

>75% CP-II

Urine coproporphyrin in congenital conjugated hyperbilirubinemia

Dubin Johnson - 80% CP-I | Rotor CP-I increased but not as much as former

Routes of transmission of hepA

Feco oral | Percutaneous(rarely)

Most common presentation of hepatitis A

Most people <5yrs are asymptomatic

Prodrome in hepA

More severe | Esp diarrhoea

Risk of fulminant hepatitisA

Co-infetion with hepatitis C

Higher incidence of cholestatic phase is found in which hepatitis

Most common mode of hepatitis infection

Acquired perinatally- mostly during delivery

Max risk of hepB transmission to foetus

HbeAg+ve mom

Breast feeding and hepB transmission

No added risk except in cracked nipple

Age of acquisition and risk of chronic hepatitis B

Older age,less chance

Higher incidence of Extrahepatic manifestations is seen with which hepatitis

HepB

Common Extrahepatic manifestations in hepB

Skin Joint Less commonly kidney

Earliest serological marker in hepB infection

HbSAg

Maximum risk of fulminat hepatic failure is seen in which hepatitis

Post vaccination testing of child born to hepB positive mother and course of action

HbSAg+ antiHbSAg - :infected,refer to hepatologist Only antiHbSAg + :immune to HBV Both absent: revaccination

Care of baby born to hepB positive mother

HBIG at birth followed by zero dose of HbSAg vaccine Accelerated course 1,2 and booster at 12 months

Double dose of HbSAg vaccine is given for

Haemophiliacs Haemolytic Anemia Leukemia

Commonest cause of CLD in west

HepC

Most common mode of transmission of hepC

IV drug abuse Second : sexual

Which has higher risk of perinatal transmission | HepB or C

Hepatitis B

Co-infection and super infection of HDV presentation

Co-infection: severe acute hepatitis | Super infection: chronic hepatitis(risk of fulminat hepatic failure maximum)

Bad prognostic factors in viral hepatitis

Falling liver size and liver enzymes | Rising SB and PT

Anicteric hepatic encephalopathy

Reyes syndrome

?Cause of Reyes syndrome

Inborn error of CoA dehydrogenase | Accumulation of CoA esters

Etiology of Reyes

Varicella Influenza Precipitated by aspirin

Age group affected in Reyes

2-15

Prominent early symptom in Reyes

Vomiting

Lab values in Reyes

``` Bilirubin: normal Liver enzymes elevated PT increased Hypoglycaemia Hyperammonemia ```

Dermatitis in hepatitis B

Gianotti crosti syndrome

Infantile Papular acrodermatitis

Most common cause for GC syndrome

Hepatitis B | EBV

Indications for IV fluids other than in severe dehydration

Sepsis Unable to drink Severe vomiting Malnutrition

Indications for antibiotics in infants with diarrhoea

Bloody Parenteral Suspected cholera

Use of conventional ORS in kwashiorkor leads to

Edema

Low osmolar ORS has all electrolytes in low conc except

Potassium | citrate

Rehydration used in diarrhoea in PEM

Resomal

Resomal has high concentrations of

K+

Extra nutrients in resomal

Mg Zn Cu

Importance of evaluating Intrahepatic cholestasis

To identify Billiary atresia

Billiary atresia should be corrected by

Less than 8weeks

Commonest cause of Intrahepatic neonatal cholestasis

Idiopathic

Infections causing cholestasis

``` TORCH hepatitis HIV ParvoB19 Reo E.coli sepsis ```

Metabolic causes of neonatal cholestasis

``` Aminoacid Tyrosinemia CHO Galactosemia Fructosemia GSDIV LIPID nieman pick Gaucher Wolman INHERITED Alpha1 anti trypsin CF neonatal iron storage disease ```

Endocrine causes of cholestasis

Hypopitutrism | Hypothyroidism

Chromosomal disorders causing neonatal cholestasis

Down | Edward

Miscellaneous causes of neonatal cholestasis

``` Zellweger Watson alagille Byler Neonatal lupus Histiocytosis X ```

Conventional ORS is essential in

Adult cholera

Extrahepatic causes of neonatal cholestasis

``` EHBA choledochal cyst Inspissated bile Sclerosing cholangitis Bile duct stenosis ```

Stool color in neonatal hepatitis

Intermittently yellow

Duodenal aspirate in EHBA

Never bile stained

USG of EHBA

Gall bladder never seen

Scintiscan in neonatal hepatitis

Reduced uptake | Bowel visualised

Scintiscan in EHBA

Good uptake | No visualisation

Liver biopsy in neonatal hepatitis

Distortion of hepatic architecture | Inflammation with early giant cells

Liver biopsy in EHBA

Bile duct proliferation | Bile lakes

Investigation of choice for EHBA

PERoperative cholangiogram

Gamma glutamyl transpeptidase is increased in all causes of neonatal cholestasis except

BYLER disease

Indicators of cholestasis

Gamma glutamyl transpeptidase Serum cholesterol 5- nucleotidase Alkaline phosphatase

Classic galactosemia

Defect in galactosyl 1 PO4 uridyl transferase

Presentation of galactosemia

``` VOMITING convulsions Jaundice Cataract Hepatosplenomegaly Hypoglycaemia Mental retardation FTT ```

Increased risk of which infection in galactosemia

E.coli sepsis

Diagnosis of galactosemia

Reducing substance in urine Dipstick(glucose oxidase) negative Deficient enzyme in RBC

Result of Rx of galactosemia

Prevents liver cirrhosis | REGRESSION of cataract

Manifestation of galactokinase deficiency

Cataract alone

A 3mon old baby started on formula feeds one week back presents with vomiting and seizures.examination reveals jaundice and hepatomegaly. The most likely diagnosis

Hereditary fructose intolerance

Conjugated bilirubinemia

Con.bil>2mg% Or >20% of TB

31.5.2013(pediatrics) 23 Flashcards

(105 cards)