Flashcards in Paediatrics Deck (99)
What are the clinical abdominal signs of intussusception?
Abdominal distension, tenderness, sausage-shaped mass on palpation.
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
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
What are contra-indications to managing intussusception with an air enema?
Peritonism (i.e. Guarding, Rebound tenderness, rigid abdomen)
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%).
What organisms are common causes of intussusception?
Viral - Rotavirus, adenovirus, HHV-6
Amoebomata, shigella, yersinia.
What is Meckel's Diverticulum?
A congenital bulge of the small intestine, usually ileal, which is a remnant of the yolk stalk.
How can Meckel's Diverticulum present?
Painless rectal bleeding (melena)
What are patients with Meckel's Diverticulum at risk of developing?
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
How should you manage a Meckel's Diverticulum?
Small bowel resection
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
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.
Abdo USS = outline the 'dough-nut' ring of the hypertrophic stenosis.
can sometimes do x-rays with contrast agent.
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
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"
Febrile illness recently?
Illnesses that are ongoing?
What does AVPU stand for?
Easy Paediatrics book:
What's the fluid requirement for children weighing 0-10kg?
Easy Paediatrics book:
What's the fluid requirement for children weighing 10-20kg?
1000 + [50mL for each kg over 10] mL/kg/24hr
Easy Paediatrics book:
What's the fluid requirement for children weighing >20kg?
1500 + [20mL for each kg over 20] mL/kg/24hr
What is the initial management of DKA?
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
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.
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.
Causes of short stature (it's a mnemonic!)
Bone (rickets, achondrodysplasia, scoliosis)
Chromosome (Down's, Turner's)
Endocrine (low GH, Cushing's, hypothyroidism)
GI malabsorption (Crohn's, Coeliac)
What are the causes of true (gonadotrophin-dependent) precocious puberty (it's a mnemonic!)
"FACT" (i.e. facts are true!)
Acquired (post-sepsis, surgery, radiotherapy)
Central (neurofibromatosis, hydrocephalus)
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)
Exogenous sex steroids
Gonadal (ovarian/testicular tumour)
Adrenal (CAH, tumour)
Syndrome - McCune-Albright
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
Causes of delayed puberty?
Gonadotrophins are either low or high.
Congenital - familial or sporadic
Hypothalamic-pituitary, e.g. panhypopituitarism or GnRH deficiency
Emotional, e.g. anorexia nervosa
Tumour (intracranial), e.g. prolactinoma.
High "Gonadotrophins Climb Stairs"
Chromosomal - klinefelter
Steroid hormone deficiencies
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
Neonate with pinpoint white papules over the nose and cheeks
Sebaceous gland hyperplasia