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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