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Phase 3a > Paeds 3 > Flashcards

Paeds 3 Flashcards

1
Q

What is the presentation of a malrotation/volvulus?

A
  • bilious vomiting

- abdominal distension

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2
Q

How do you manage malrotation/volvulus?

A
  • contrast study for diagnosis

- urgent surgical referral

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3
Q

How does hirschsprung’s/meconeum ileus/intestinal atresias ppresent?

A

-delayed passage of meconium
-abdo distension
-bilious vomiting
(surgical referral)

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4
Q

How does NEC present?

A
  • usually prem
  • abdo distension
  • bilious vomiting
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5
Q

How do you treat NEC?

A
  • ABx
  • enteral rest - PTN
  • surgical referral if severe
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6
Q

How does Paediatric GORD present?

A
  • vomiting associated with feeds
  • faltering growth
  • oesophagitis +/- strictures
  • apnoea whilst feeding
  • aspiratino, wheezing, hoarseness
  • iron deficiency anaemia
  • torticolis
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7
Q

How do you treat paediatric GORD?

A
  • reassurance that this is normal
  • position whilst feeding
  • smaller more frequent feeds
  • thicker feeds
  • if persists offer alginate therapy
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8
Q

How does food intolerance present and how do you manage it?

A
  • vomiting
  • diarrhoea or constipation
  • eczema, puritis, erythema, angioedema lips, face and eyes
  • LRT symptoms - wheeze
  • IgE mediated - URT sneezing, rhinorrhoea or coongestion

-elimination diet

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9
Q

How does pyloric stenosis present?

A
  • progressive projectile vomiting
  • hypokalaemic
  • hypocholoric
  • METABOLIC ALKALOSIS
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10
Q

How do you manage pyloric stenosis?

A

-fluid and electrolyte placement prior to corrective surgery

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11
Q

How does intussusception present?

A
  • 3 to 36 months of age
  • colicky abdo pain
  • bilious vomiting
  • RECURRENT JELLY STOOLS
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12
Q

How do you manage an intussusception?

A

-air or barium enema for reduction

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13
Q

How does a strangulated hernia/adhesion obstruction present?

A
  • bilious vomiting

- abdo pain

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14
Q

How may DKA present?

A
  • polydipsia
  • polyuria
  • hyperglycemia
  • ketonuria
  • metabolic acidosis
  • HYPOKALAEMIA
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15
Q

How does acute appendicitis present?

A
  • anorexia
  • central abdo pain migrating to the RIF
  • vomiting
  • pyrexia
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16
Q

What are some complications of vomiting excessively?

A
  • hypokalaemia
  • alkalosis
  • hyponatraemia
  • nutritional losses
  • Mechanical damage - mallory-weiss tear. tears of short gastric arteries
  • dental erosions/caries
17
Q

Name 3 antiemetics.

A
  • cyclizine
  • promethazine
  • prochlorperazine - medication NV
  • metoclopramide
  • droperidol
  • ondanzatron - PONV
18
Q

What are the red flags associated with vomiting?

A
  • meningism
  • costovertebral tenderness
  • abdo pain
  • any evidence of raised ICP: bulging fontanelle, worse in morning
19
Q

How do you investigate GORD?

A
  • pH test
  • Barium swallow and meal
  • endoscopy
  • PPI test
20
Q

What are red flags for constipation?

A
  • delayed passage of meconium
  • fever, vomiting
  • failure to thrive
  • tight empty rectum with palpable abdo mass
  • abnormal neuro exam
21
Q

What are the long term complications of constipation?

A
  • acquired MEGACOLON
  • anal fissures
  • overflow incontinence
  • behavioural problems
22
Q

How do you manage constipation conservatively?

A
  • explanation of normal function of bowel
  • diet/fluids and exercise
  • behavioural advice
  • toilet training advice
  • simple reward schemes
23
Q

How would you medically manage constipation?

A
  • softener: lactulose, liquid paraffin
  • bulking agent: fybrogel
  • movicol
  • senna
  • phosphate enema
  • anal fissure: anaesthetic cream +/- vasodilator
24
Q

define diarrhoea.

A

-change in consistency of stools
and/or
-increased frequency of evacuations +/- fever or vomiting which lasts less than 7 days but not longer than 14

25
Q

What factors do you look at when assessing a child’s hydration status?

A 
-level of activity:
~irratibility/restlessness = mild - moderate 
~abnormal sleepiness/lehtargy = severe 
-sunken eyes
-want of water:
~eager to drink - mild/moderate 
~drinking poorly or not at all =severe 
-Skin turgor:
~visible for less than 2 secs = mild/moderate 
~visible for longer than 2 secs = severe
26
Q

When do you perform stool micrbiology?

A
  • suspected sepsis
  • blood or mucus in stool
  • immunocompromised

Consider:

  • recent travel abroad
  • greater than 7 days of diarrhoea
  • uncertain of diagnosis of GE
27
Q

WOOO IBD - What’s the difference between chron’s and UC?

A

C -mouth to anus
UC - colon only

C - Transmural inflammation
UC - muscosal inflammation

C - granuloma
UC - no granuloma

C - rectal sparing
UC - no rectal sparing

C - fissures, fistula, abscesses and strictures
UC - above rare

extras
C- perianal disease
UC - primary sclerosing cholangitis

28
Q

main difference between adult and paed’s IBD is GROWTH. Discuss.

A
  • poor growth
  • delayed puberty
  • reduced final adult height
  • persistent poor growth may be the only sign of disease activity
29
Q

What’s the treatment for induction and remission in mild to moderate IBD?

A

Induction - aminosalicylates

remission - aminosalicylates

30
Q

What’s the treatment for induction and remission in severe IBD?

A

Induction - corticosteroids

Remission - mercaptopurine (6 MP) or Azathioprine

31
Q

What’s the fluid dose for a bolus?

A

20 ml/kg 0.9% NaCl

32
Q

What 3 instances do you not give 20 ml/kg 0.9%NaCl as a bolus? What dose instead?

A
  • DKA
  • Trauma
  • Neonates

-10 ml/kg 0.9 NaCli

33
Q

What is the usual causative agent of a UTI in paeds?

A

E Coli

34
Q

Following the identification of a UTI, what elseshould you do?

A

USS of kidney/ueter to see wagwan

-DMSA/MCUG depending on age, severity and type of organism.

35
Q

What is the most common paediatric malignancy?

A

leukaemia

-ALL most common

36
Q

What are the Sx of ALL?

A

-anaemia, pallor, fatigue
-infections
-bruising, nose bleeds
(bone marrow failure Sx)

Phase 3a (15 decks)

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