Paediatrics Flashcards Preview

Random Bits > Paediatrics > Flashcards

Flashcards in Paediatrics Deck (99)
1

What are the clinical abdominal signs of intussusception?

Abdominal distension, tenderness, sausage-shaped mass on palpation.

2

What investigations would you perform for ?intussusception and what would you be looking for?

Abdominal USS - may reveal the mass, 'target' appearance
AXR - small bowel obstruction (fluid levels, dilated loops of small bowel)
Air enema - may be therapeutic as well as diagnostic

3

How would you manage intussusception?

Inital fluid resus as needed - 'drip and suck' = NG tube and IV fluids
Air (or contrast) enema reduction
Surgical reduction +/- resection if enema contra-indicated

4

What are contra-indications to managing intussusception with an air enema?

Rectal bleeding
Peritonism (i.e. Guarding, Rebound tenderness, rigid abdomen)

5

What are common pathological causes of intussusception?

Meckel's diverticulum (75%).
Polyps and Peutz-Jeghers syndrome (16%).
Henoch-Schönlein purpura (3%).
Lymphoma and other tumours (3%).

6

What organisms are common causes of intussusception?

Viral - Rotavirus, adenovirus, HHV-6
Amoebomata, shigella, yersinia.

7

What is Meckel's Diverticulum?

A congenital bulge of the small intestine, usually ileal, which is a remnant of the yolk stalk.

8

How can Meckel's Diverticulum present?

Asymptomatically
Painless rectal bleeding (melena)
Epigastric pain
Mimics appendicitis

9

What are patients with Meckel's Diverticulum at risk of developing?

Intestinal obstruction
Volvulus
Intussusception

10

What diagnostic test would you like to perform to confirm your ?meckel's diverticulum

A technetium scan - gastric mucosa of the diverticulum show increased uptake

11

How should you manage a Meckel's Diverticulum?

Small bowel resection

12

What is the "rule of 2's" for Meckel's Diverticulum?

2% of population affected
2 inches long
2 feet proximal to ileocaecal valve
2 types of mucosa - gastric and pancreatic
2 years old is a common age of presentation
2:1 male:female

13

What investigations would you like to perform for ?pyloric stenosis

FBC, Glucose, Serum electrolytes (low Cl, low potassium)
LFTs if jaundiced
Blood gas - venous or capillary (alkalosis)

Test feed = infant feeds, palpate olive mass and observe for peristalsis moving from left to right.

or

Abdo USS = outline the 'dough-nut' ring of the hypertrophic stenosis.

can sometimes do x-rays with contrast agent.

14

How would you manage a child with pyloric stenosis?

NBM, NG tube with aspirations
Fluid monitoring and correct dehydration - something with KCl and dextrose in.
Regular BM and serum electrolyte/pH monitoring.
Once stable - discuss with surgeons for ?pyloromyotomy

15

What do you want to know in a status epilepticus history? (it's a mnemonic!)

Duration of convulsions and any treatment given already?

also, "PEE FIT"
Poisons ingested?
Epilepsy history?
Eaten recently?
Febrile illness recently?
Illnesses that are ongoing?
Trauma recently?

16

What does AVPU stand for?

Alert
Voice responsive
Pain Responsive
Unresponsive

17

Easy Paediatrics book:
What's the fluid requirement for children weighing 0-10kg?

100-120 mL/kg/24hr

18

Easy Paediatrics book:
What's the fluid requirement for children weighing 10-20kg?

1000 + [50mL for each kg over 10] mL/kg/24hr

19

Easy Paediatrics book:
What's the fluid requirement for children weighing >20kg?

1500 + [20mL for each kg over 20] mL/kg/24hr

20

What is the initial management of DKA?

ABCDE approach
If shocked, fluid bolus 10mL/kg 0.9% saline
BM, U+Es, blood gas (venous or capillary)
Maintain potassium levels by giving potassium in each IV bag
Insulin IV after beginning IV fluids

21

intraventricular haemorrhage is most commonly associated with the development of what type of cerebral palsy?

spastic diplegic cerebral palsy
because of the anatomical proximity to the corticospinal tracts.

22

What does seborrhoeic dermatitis present like?

erythematous rash with yellow flakes in first few weeks of life.
Affects the scalp, nappy area, face and limb flexures.

23

Causes of short stature (it's a mnemonic!)

"ABCDEFG"
Alone (neglect)
Bone (rickets, achondrodysplasia, scoliosis)
Chromosome (Down's, Turner's)
Delayed
Endocrine (low GH, Cushing's, hypothyroidism)
Familial
GI malabsorption (Crohn's, Coeliac)

24

What are the causes of true (gonadotrophin-dependent) precocious puberty (it's a mnemonic!)

"FACT" (i.e. facts are true!)

Familial
Acquired (post-sepsis, surgery, radiotherapy)
Central (neurofibromatosis, hydrocephalus)
Tumours

25

What are the causes of false (gonadotrophin-independent) precocious puberty (it's a mnemonic!)

"HE GAS" (i.e. he gasses a lot of hot air = false)

Hypothyroidism
Exogenous sex steroids

Gonadal (ovarian/testicular tumour)
Adrenal (CAH, tumour)
Syndrome - McCune-Albright

26

What are the triad of symptoms in McCune-Albright syndrome?

- Precocious puberty
- polyostotic fibrous dysplasia
- Cafe-au-lait spots that are large with irregular borders stopping at midline

27

Causes of delayed puberty?

Gonadotrophins are either low or high.

Low "CHEST":
Congenital - familial or sporadic
Hypothyroidism
Hypothalamic-pituitary, e.g. panhypopituitarism or GnRH deficiency
Emotional, e.g. anorexia nervosa
Systemic Disease
Tumour (intracranial), e.g. prolactinoma.

High "Gonadotrophins Climb Stairs"
Gonadal dysgenesis
Gonadal disease
Chromosomal - klinefelter
Steroid hormone deficiencies

28

Neonate in first few days of life develops a diffuse macular rash with papules and pustules predominantly on the trunk. The infant is well and goes on to resolve within 2 days. This recurs over the next two weeks.

Erythema toxicum neonatorum
- occurs in first few days of life
- blotchy red papules +/- pustules
- anywhere on body (not palms/soles)
- infant WELL
- resolve in a few days but can recur over next couple of weeks

29

Neonate with pinpoint white papules over the nose and cheeks

Sebaceous gland hyperplasia

30

What are Epstein's Peals?

milia in the mouth (white keratinous cysts) along the alveolar ridge and at the junction of the hard/soft palate

31

What is the other name for Mongolian blue spot?

Dermal melanocytosis?

32

What is the other name for Dermal melanocytosis?

Mongolian blue spot

33

What causes dermal melanocytosis?

melanocytes entrapped in the dermis

34

How long does it take for dermal melanocytosis to fade?

a few years
usually all gone by puberty
very rarely for life

35

Differentials for paediatrics constipation

Intake: Diet, dehydration, too much milk
Gut passageway: stricture, anal fissure, Hirschsprung's disease
Metabolic: Hypothyroidism; cystic fibrosis; hypercalcaemia
Neuromuscular: cerebral palsy; spinal cord lesions
Drugs: narcotics, antidepressants

36

What is the first-line medical treatment for faecal impaction?

Macrogols (polyethylene glycol 3350) and electrolytes

37

What is first-line maintenance therapy in constipation?

Macrogols (polyethylene glycol 3350) and electrolytes

in conjunction with diet and lifestyle advice

38

How should the maintenance therapy in constipation be adjusted if the patient doesn't respond to the first-line treatment?

First-line is polyethylene glycol 3350 + electrolytes.

If there is little responsethen add a stimulant laxative, e.g. senna, to the first-line.

39

How long should a child be on maintenance therapy for constipation?

Several weeks after the first normal bowel movement - don't stop the medications abruptly

40

What diet + lifestyle advice would you offer to the parent of a child with constipation?

Lifestyle:
- scheduled toilet time
- Bowel diary
- Reward system

Intake:
- Encourage adequate fluid intake
- Encourage adequate fibre intake (fruit, vegetables)

41

How should you manage faecal impaction?

1st-line: macrogol (polyethylene glycol) and electrolytes
2nd-line: if no improvement after two weeks add a stimulant (e.g. senna) to the macrogol

Consider rectal medications if the above fails
Consider enema if the above fails
Consider manual evacuation under anaesthetic if the above fails

42

What are big red flags in a constipation history?

Constipation from birth or first few weeks of life
Failure to pass meconium in first 48 hours of life
Abdominal distension with vomiting
Weakness in legs or locomotor delay

43

What are red flags in an examination for constipation?

Abnormal appearance/position/patency of anus
Gross abdominal distension

Abnormal spine/gluteal region
Abnormal neurological reflexes

44

What are long term complications of constipation?

Faecal impaction --> overflow diarrhoea
Megacolon --> risk of ulcers and perforation
Anal fissures --> pain and chronic fissures
Psychological and behavioural effects

Basically: blockages, tears and psych

45

How would you manage an anal fissure?

Osmotic laxative and pain relief (e.g. paracetamol or ibuprofen)

46

How might a child with Hirschprung Disease present?

Failure to pass meconium in first 48 hours of life
Vomiting
Abdominal distension
Explosive bowel movements, particularly following examination

47

What genetic condition is associated with Hirschprung Disease?

Down syndrome

48

What specific investigations would you like to perform for Hirschprung Disease?

Consider Abdominal X-ray (megacolon) or contrast enema

Definitive: Rectal biopsy demonstrating absent ganglions (older children require anaesthetic)

49

What is the management for Hirschprung Disease?

Bowel irrigation (this is not an enema)
- involves small volume of liquid introduced into rectum
- repositioning a tube to evacuate gas and liquid from the rectum.

Definitive surgery:
- Removal of aganglionic section and pull-through of normal ganglionic section to rectum
- usually done by first few months of life

50

What are the differentials for reflux?

Possetting (physiological passive reflux)
Allergy (skin rash, vomiting, diarrhoea --> use special formula)
GORD ( weakness or inappropriate relaxation of oesophageal sphincter)
Oesophageal stricture
Pyloric Stenosis

51

What are common causes of pharyngitis?

Viral: Adenovirus or parainfluenza virus
Bacterial: Group A Streptococcus

52

What are the treatment options for pharyngitis?

Antipyretics and fluids
Antibiotics if ?bacterial

53

How would a child with laryngomalacia present?

Stridor ('floppy' airway that collapses on inspiration)
Develops early in life (like days)

54

What investigation might you perform to diagnose laryngomalacia?

Laryngoscopy

55

How would you manage a child with laryngomalacia?

Reassurance - most cases will resolve with time
Rule out GORD
If severe, consider surgical review for endoscopic supraglottoplasty

56

What is the treatment for moderate/severe croup?

Consider oxygen if below 92%
Oral dexamethasone (0.15mg/kg)
Paracetamol or ibuprofen for fever and pain relief

Consider neubulised adrenaline
Consider intubation and ventilation if not responding to treatment

57

What is the organism that causes whooping cough?

Bordetella Pertussis

(Gram negative coccobacillus)

58

What are the symptoms/stages of whooping cough?

Catarrhal stage:
- runny nose, conjunctivitis, wheeze
- lasts one to two weeks

Paroxysmal stage:
- Coughing with whoop and vomiting
- May have apnoeas following coughing spasms
- up to three months

Convalescence:
- Resolution of symptoms
- around two weeks

59

What is the management for whooping cough?

Admit if less than 6 months old or if severe breathing difficulties

Prescribe antibiotics to patient and close contacts:
- less than 1 month old = clarithromycin
- greater than 1 month old = clarithromycin or azithromycin
- pregnant = erythromycin

60

What should patients be advised regarding staying off school with whooping cough?

Stay off school for 5 days after starting antibiotics

OR

Three weeks after onset of cough

... whichever is sooner

61

How can the causes of ataxia be classified?

Acute or Chronic
Intermittent or Progressive

62

An enlarged 4th ventricle with cerebellar hypoplasia. The patient has an increased head circumference, ataxia and signs of raised ICP.

Dandy-Walker syndrome

characterised by the enlarged 4th ventricle and cerebellar hypoplasia

63

An autosomal recessive condition that leads to degeneration of cerebellar tracts and dorsal columns displaying progressive ataxia, lower limb weakness, loss of deep tendon reflexes and many more signs.

Friedrich ataxia

64

A non-progressive brain lesion within the developing brain that develops during the antenatal, neonatal or early postnatal period. Impacts upon cognition, sensory, motor, communication and psychological domains.

Cerebral Palsy

65

Categories and examples of cerebral palsy causes?

Antenatal = cerebral malformation/dysgenesis or congenital infection

Intrapartum = Hypoxic-ischaemic encephalopathy (birth asphyxia)

Post-natal = Intraventircular haemorrhage, head trauma, cerebral ischaemia

66

Types of cerebral palsy?

Spastic
Dyskinetic
Ataxic

67

A cerebral palsy demonstrating velocity-dependent increased tonic stretch reflexes with clonus. It can be classified as monoplegic, hemiplegic, diplegic or quadraplegic.

Spastic cerebral palsy

68

A cerebral palsy demonstrating involuntary, recurring, stereotyped movements with varying tone.

Dyskinetic cerebral palsy

69

A cerebral palsy demonstrating hypotonia, poor balance and coordination as well as a tremor.

Ataxic cerebral palsy

70

What investigations would you like to order for a patient demonstrating signs of cerebral palsy?

MRI brain
Congenital infection screen
Metabolic screen

71

Who from the MDT would you involve in the management of a patient with cerebral palsy?

Movements: OTs, PTs, SALT
Development: Social worker, teacher, developmental psychologists
Health: Paediatricians, orthopaedics, neurology, audiology, ophthalmology

72

What is the treatment for a breath holding spell?

Reassurance
Most kids grow out of them

73

An arthritic type picture affecting less than 4 joints?

oligoarthritis

74

An arthritic type picture affecting more than 5 joints?

polyarthritis

75

Treatment for JIA?

DMARDs = methotrexate/sulphasalazine
NSAIDs = ibuprofen
oral corticosteroids = prednisolone

76

Teenager with limited hip movement, external rotation but decreased internal rotation.
Antalgic gait, pain down to knee.

Slipped upper femoral epiphysis

77

Management of slipped upper femoral epiphysis?

Don't walk
Pain killers
Ortho referral for surgical fixation with pin

78

Interruption of blood supply to femoral head leading to necrosis

Perthes disease

79

What are risk factors for developmental dysplasia of the hip?

Oligohydramnios
Breech position
Prematurity
Great than 5kg birth weight
Positive family history
Spinal problems

80

What is the Barlow test?

flex and adduct baby legs and push posteriorly on knee

81

What is ortolani test?

flex, anterior pressure on thigh and abduct - should feel a clunk

82

When are a baby's hips checked for hip dysplasia?

within 72 hours of birth
again at 6 week check

83

Management for a child less than 6 months old with developmental dysplasia of the hip?

Pavlik's harness

84

Management for a child older than 6 months or if first-line management didn't work?

Closed reduction (anaesthetic and cast with imaging) for 12 weeks

85

Management for a child in which 2nd-line treatment didn't work?

open reduction

86

What's the problem if developmental dysplasia of the hip is not treated?

Arthritis of the hip --> pain and movement issues later in life

87

Inflammation of the patellar tendon at the tibial tubercle with pain below the knee

Osgood-schlatter (apophysitis of the tibial tubercle)

88

What investigations for Duchenne Muscular Dystrophy?

Creatine Kinase (massively elevated)
Biopsy (lack of dystrophin)
EMG
Genetics (Xp21)

89

What signs of Duchenne Muscular Dystrophy?

Gower's sign - lying then rolling onto front and using knees to get back up
Trendelenburg gait
Calf pseudohypertrophy (fat/connective tissue replaces muscle)

90

What age does Duchenne Muscular dystrophy tend to present?

3 years old

91

Prognosis of Duchenne Muscular dystrophy?

life expectancy of 20s/30s

92

Common causes of neonatal conjunctivits?

Staph Aureus
Neisseria Gonorrhoea
Chlamydia Trachomatis
Chemical irritants

93

Common causes of infant/young child conjunctivitis?

Staph aureus
Streptococcus pneumoniae
Haemophilus influenza
Moxarella

94

Treatment of neonatal conjunctivitis?

Chloramphenical eyedrops
chlamydia = erythormycin and tetracycline
Gonococcus = penicillin eye irrigation

95

Treatment of infant/young child conjunctivitis?

Fusidic acid/chloramphenicol/neomycin

96

Signs/symptoms in periorbital vs orbital cellulitis?

periorbital = basically normal eye movements/reflexes/vision etc
Orbital = inflamed conjunctiva/sclera, impaired reflexes/vision

97

Management of periorbital/orbital cellulitis?

peri=oral, orbital=broad spec IV
ENT team to r/o sinus involvement
ophthalmology input

98

Management of retinoblastoma?

Chemo/radiotherapy
If local involvement - enucleation (removal of eye!)

99

Management of congenital adrenal hyperplasia?

Hydrocortisone (lifelong) oral
If salt-wasting CAH --> fludrocortisone
Surgery for virilised genitalia