Paediatrics Flashcards
1
Q
Aetiology of Meckel Diverticulum
A
Ileal remnant of vitello-intestinal duct
2
Q
What type of tissue does Meckel Diverticulum contain?
A
Ectopic gastric mucosal pancreatic tissue
3
Q
Presentation of Meckel Diverticulum
A
Mostly asymptomatic
Severe rectal bleeding, intussusception, volvulus, diverticulitis
4
Q
Investigation of Meckel Diverticulum
A
Technetium scan
5
Q
Management of Meckel Diverticulum
A
Surgical resection
6
Q
Aetiology of Biliary atresia
A
Extra-hepatic bile ducts obliterated by inflammation and fibrosis –> biliary obstruction –> jaundice
7
Q
Presentation of Biliary atresia
A
Jaundice
FTT
Conjugated hyperbilirubinaemia
8
Q
How is Biliary atresia diagnosed?
A
Liver histology
9
Q
Management of Biliary atresia
A
Surgery
10
Q
Presentation of Duodenal atresia
A
Polyhydramnios
Persistent billious vomiting, within hours of birth
11
Q
Investigation of Duodenal atresia
A
Can diagnose on USS
Double bubble sign on x-ray
12
Q
Which genetic condition is Duodenal atresia associated with?
A
Trisomy 21- Down’s Syndrome
13
Q
Management of Duodenal atresia
A
Surgery
14
Q
Define Gastro-oesophageal reflux
A
Non-forceful regurgitation of milk and other gastric contents into the oesophagus
15
Q
Aetiology of GORD
A
Incompetent sphincter at the Gastro-Oesophageal junction
16
Q
Risk factors for GORD in children
A
Prematurity
Hiatus hernia
17
Q
Presentation of GORD in children
A
Epigastric pain
Recurrent regurgitation/vomiting
Episodes of choking
FTT
18
Q
How is GORD diagnosed?
A
Clinically
19
Q
Management of GORD in children?
A
Thickened feeds, alginate formula
PPI/H2 receptor antagonist
Fundoplication
20
Q
Which sign is seen on x-ray in Duodenal atresia?
A
Double bubble sign
21
Q
At what age does Cow’s milk protein allergy usually present?
A
< 1 year old
22
Q
Types of Cow’s milk protein allergy
A
IgE or non-IgE
23
Q
How can a breast-fed baby present with Cow’s milk protein allergy?
A
It can be a reaction to mum’s consumption of Cow’s milk
24
Q
How does Cow’s milk protein allergy present?
A
IgE: within 2 hours; skin itchy, V+D, wheeze, cough
Non-IgE: within hours/days; atopic eczema, reflux, constipation/diarrhoea, FTT
25
Diagnosis of Cow's milk protein allergy
IgE: skin prick test
| Non-IgE: exclusion + see
26
Management of Cow's milk protein allergy
Hydrolysed/elemental formula
| Anti-histamines for acute IgE
27
What is the typical appearance of stool in Toddler's Diarrhoea?
Peas and carrots
| 1st stool of day large, then others small
28
At what age does Toddler's Diarrhoea typically present?
6-20 months
| Usually resolves by age 5
29
Management of Toddler's Diarrhoea
Adequate fat and fibre to slow gut
30
What is Gastroschisis?
Bowel protrudes through a defect in the anterior abdominal wall, no covering sac
Risk of dehydration and protein loss
31
Management of Gastroschisis
Abdomen wrapped in film to protect
NG tube aspirated
IV dextrose infusion
Surgery
32
What is the difference between Gastroschisis and Exomphalos?
Exomphalos is covered by a sac, Gastroschisis is not
33
What is Exomphalos?
Abdominal contents protrude through the umbilical ring, transparent sac formed by amniotic membrane and peritoneum
34
Management of Exomphalos
Surgery
35
At what age does Pyloric Stenosis typically present?
2-8 weeks old
36
Presentation of Pyloric Stenosis
Projectile vomiting, not bile-stained (as above ampulla of vater)
Weight loss, FTT, hungry after feeds
Visible gastric peristalsis, palpable abdominal mass
37
How is Pyloric Stenosis diagnosed?
USS abdomen
38
What electrolyte abnormalities are seen in Pyloric Stenosis?
Vomiting --> Hypokalaemia, hypochloraemia
| Metabolic alkalosis
39
Management of Pyloric Stenosis
Rehydration + electrolytes
| Ramstedt's pylorotomy
40
What is the most common location for Intussusception?
Proximal bowel into distal bowel
| Ileum into caecum via the ileo-caecal valve
41
What is the most common age of presentation of Intussusception?
3 months - 2 years
42
Presentation of Intussusception
Severe colicky abdominal pain, draws knees up to chest, pale, screaming in pain, vomiting (may become billious)
Redcurrent jelly stool
RLQ sausage-shaped mass
43
In which condition is redcurrent jelly stool and a RLQ sausage-shaped mass seen?
Intussusception
44
How is Intussusception diagnosed?
Abdominal USS
| - Target sign
45
What is seen on Abdominal USS in Intussusception?
Target sign
46
Management of Intussusception
Rectal air insufflation
47
Aetiology of Intestinal Malrotation
Congenital anomaly of rotation of the midgut --> obstruction --> volvulus --> infarction
48
At what age does intestinal malrotation typically present?
Day 1-7
49
Presentation of intestinal malrotation
Billious vomiting, abdominal pain, tenderness
50
How is intestinal malrotation diagnosed?
Upper GI contrast study
51
Management of intestinal malrotation
SURGICAL EMERGENCY
| Surgery- Ladd's procedure- rotates bowel anti-clockwise
52
Causes of jaundice in babies < 24hrs old
TORCH infection
Haemolytic eg rhesus incompatibility
G6PD deficiency
53
Causes of jaundice in babies age 24hrs-2 weeks
Physiological (or infection)
54
Causes of jaundice in babies age > 2 weeks
```
TORCH infection
Hypothyroidism
Pyloric Stenosis
Biliary atresia- pale stool + raised conjugated bilirubin
Neonatal hepatitis
```
55
What infections are included in TORCH screen?
Toxoplasma
Rubella
CMV
Herpes Simplex Virus
56
What is Necrotising Enterocolitis?
Bacterial invasion of ischaemic bowel wall
57
In what group is Necrotising Enterocolitis most common?
Premature babies
58
When does Necrotising Enterocolitis usually present?
In the 1st few weeks
59
Presentation of Necrotising Enterocolitis
Billious vomiting, abdominal pain + distension, fresh blood in stool
60
Investigations of Necrotising Enterocolitis
Investigations for sepsis
| Abdominal x-ray
61
What is found on abdominal x-ray in Necrotising Enterocolitis?
Distended bowel loops, thickening of bowel wall with intramural gas
Football sign on x-ray
62
Management of Necrotising Enterocolitis
ABCDE if shocked
Stop oral feeds
Broad spectrum Antibiotics
Surgery for perforation
63
Aetiology of Hirschsprung's disease
Large bowel obstruction due to absence of ganglionic cells from myenteric plexus of large bowel
64
What is the most commonly affected portion of bowel in Hirschsprung's disease?
Recto-sigmoid
65
Presentation of Hirschsprung's disease
Failure to pass meconium within 1st 48hrs of life
| Later bile-stained vomit
66
Risk factors for Hirschsprung's disease
Boys
| Downs syndrome
67
What is found on PR examination in Hirschsprung's disease?
Withdrawal causes flow of liquid stool + flatus
68
How is Hirschsprung's disease diagnosed?
Suction rectal biopsy is diagnostic
69
Management of Hirschsprung's disease
Enema + surgical resection
70
Aetiology of Kernicterus
Unconjugated bilirubin is deposited in the basal ganglia
| Causes encephalopathy- seizures, coma and choreoathetoid cerebral palsy
71
Management of neonatal jaundice
Phototherapy
| Exchange transfusion
72
What are the 3 features of Nephrotic Syndrome?
1. Hypoalbuminaemia < 25g/L
2. Proteinuria > 1
3. Oedema
73
Causes of Nephrotic Syndrome
Minimal change disease
| Post-strep nephritis
74
Management of Nephrotic Syndrome
Steroid-sensitive- Prednisolone PO
Not steroid-sensitive- Diuretics, salt restriction, ACEi, NSAIDs
Cyclophosphamide
75
Clinical features of Haemolytic uraemic syndrome
Acute renal failure
Thrombocytopenia
Microangiopathic haemolytic anaemia
Abdo pain, reduced urine output, normocytic anaemia
76
Management of Haemolytic uraemic syndrome
Symptomatic management
| Plasma exchange if severe
77
Aetiology of Haemolytic uraemic syndrome
Usually follows bloody diarrhoea- E coli
78
Most common aetiology of Henoch-Schonlein purpura
Strep pyogenes URTI
79
Presentation of Henoch-Schonlein purpura
Purpura- rash buttocks + extensor surfaces
Arthritis
Abdo pain
Haematuria, proteinuria
80
Management of Henoch-Schonlein purpura
Oral prednisolone
81
Causes of Nephritic Syndrome
Post-streptococcal, HSP, Anti-glomerular basement membrane disease, IgA nephropathy, SLE
82
Presentation of Nephritic Syndrome
Haematuria, reduced urine output, fluid retention, proteinuria, hypertension
83
Management of Nephritic Syndrome
Diuretics
84
In what age group does Wilm's tumour typically present?
Children < 5
85
What is Wilm's tumour?
Kidney tmour
86
Presentation of Wilm's tumour
Mass in abdomen
| Abdominal pain, haematuria, lethargy, fever, hypertension, weight loss
87
Investigation of Wilm's tumour
USS Kidneys
CT abdomen
Biopsy
88
Management of Wilm's tumour
Surgical excision + nephrectomy
89
Most common causative organism of Meningitis
Neisseria meningitidis
90
Features of seizures in West syndrome
Head nodding, arm jerk, EEG shows hypsarrhythmia
91
How is Status Epilepticus defined?
Tonic clonic seizures lasting > 30 minutes
92
Management of Status Epilepticus
Buccal Midazolam --> IV Lorazepam --> IV Phenytoin
93
What are febrile seizures?
Tonic clonic seizures with a fever
94
Management of Meningitis
IM Benzylpenicillin in GP
| IV Ceftriaxone in hospital
95
Management of contacts in Meningitis
PO Rifampicin
96
Aetiology of Asthma
Reversible airway obstruction
- -> Bronchospasm
- -> Mucosal swelling + inflammation
- -> Increased mucous production --> mucous plug
97
Presentation of Asthma
Wheeze
Nocturnal cough
Diurnal variation
Intermittent dyspnoea
98
Findings on spirometry in Asthma
FEV1:FVC < 70%
| With bronchodilator reversibility > 12%
99
Management of an acute exacerbation of Asthma
```
OSHITME:
- Oxygen
- Salbutamol nebs
- Hydrocortisone IV
- Ipratropium bromide nebs
- Magnesium sulphate
- Escalate
(ABCDE)
```
100
Management of chronic Asthma
1) SABA (Salbutamol)
2) SABA + Inhaled corticosteroid (Beclomethasone)
3) SABA + ICS + Leukotriene receptor antagonist (Montelukast)
4) SABA + ICS + LABA (Salmeterol)
101
How is life-threatening Asthma defined?
3392 CHEST
- PEFR < 33% predicted
- Sats < 92%
- Cyanosis
- Hypotension
- Exhaustion
- Silent chest
- Tachycardia
102
What is the peak age for croup?
6mths - 6yrs
103
What is the causative organism of croup?
Parainfluenza virus
104
Presentation of croup
Barking cough, stridor, fever, hoarseness
| Worse at night
105
Anatomical name for croup
Laryngotracheobronchitis
106
Management of croup
Oral Dexamethasone 0.15mg/kg or nebulised Budenoside
| Severe: O2 + Adrenaline
107
What is the causative organism of acute epiglottitis?
Haemophilus influenza B
108
Presentation of acute epiglottitis
Sore throat, unable to speak/swallow
| Soft inspiratory stridor
109
Management of acute epiglottitis
DO NOT EXAMINE THROAT- medical emergency
Call anaesthetics
IV Cefuroxime
110
What is the causative organism of Whooping cough?
Bordatella pertussis
111
Presentation of Whooping cough
Inspiratory whoop- forced inspiration against a closed glottis
Coughing spasms --> vomiting
112
Diagnosis of Whooping cough
Nasal culture swab
113
Management of Whooping cough
Azithromycin 5-7 days
School exclusion
Incubation period 10-14 days
114
What is the most common causative organism of Bronchiolitis?
80% Respiratory Syncytial Virus
115
At what age is Bronchiolitis most common?
1-9 months
116
Presentation of Bronchiolitis
```
Nasal flaring
Head bobbing
Subcostal/Intercostal recessions
Tracheal tug
Grunting
High-pitched wheeze
```
117
Investigations of Bronchiolitis
PCR analysis of nasal secretions
| CXR- hyperinflation
118
Management of Bronchiolitis
Oxygen
NG feeds
Fluids
119
Genetic aetiology of Cystic Fibrosis
Autosomal recessive defect in CFTR protein on chromosome 17
| Defect in cAMP regulated chloride channels in cell membranes
120
How is Cystic Fibrosis screened for?
Guthrie heelprick age 6-9 days
