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Paediatrics Flashcards

1
Q

What are the components of a newborn examination

A 
Cardiac/resp
Red reflex
Fontanelle
Face and mouth
Abdomen
Nappy area
Hips 
Limbs
Prone
Reflexes
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2
Q

What are the components of a newborn cardiac/resp exam

A

Listen to 4 areas over the chest, including with the bell- less than 200 bpm is pathologic
- May have innocent murmurs due to flow velocity change in different sized vessels
Anterior resp auscultation is enough in absence of signs
More than 60 breaths is pathologic
Can auscultate abdomen here but low yield
- Inspect and palpate chest after auscultation

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3
Q

What are the components of a newborn red reflex exam

A
  • Baby needs to be awake and in a dimmed room, looking through ophthalmoscope with both eyes
  • Looking for asymmetry or whitening
  • Could indicate congenital cataract/glaucoma or retinoblastoma
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4
Q

Describe the anatomy of a fontanelle

A

Sutures are coronal, saggital, metopic and lambdoid

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5
Q

Describe the components of a fontanelle exam

A

Feel along sutures and both ant and post fontanelles
May initially feel as if they overlap due to pressure from birth
ABNORMAL if no suture or ridge feeling- may be due to pressure from early fusion (craniosynostosis)
Widening within the saggital suture may be due to trisomy 21
If wormian bones are present they will feel like cracked eggshell

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6
Q

Describe components of neonatal face and mouth exam

A

Look for any abnormalities in skull shape and facial symmetry (but check the parents!)
Palate- look at uvula and feel/look at palate for cleft

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7
Q

Describe component of neonatal abdominal exam

A

Inspect and palpate for masses and discoloration
Check umbilical cord for erythema- oomphalitis
Quick feel
Check for liver and spleen, starting in RIF for both
- You can palpate liver and spleen in a normal neonate
Kidneys are low yield

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8
Q

Describe the components of the neonatal nappy area exam

A

Femoral pulses
Fingers into medial hip creases to part labia in girls
Boys- fingers right behind scrotum to check for testes, feeling down
Lift legs up to examine anus

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9
Q

Describe the components of the neonatal hip examination

A

Barlow and ortolani’s test

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10
Q

Describe barlow’s test

A

Can it dislocate?

Femur adducted, press down and out

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11
Q

Describe the ortolani test

A

Can the hip go back in?

Abduct femur, press in and up

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12
Q

Describe the limb exam for the neonate

A

Count and assess fingers and toes

Check for palmar creases (glyphs)- only one crease in down syndrome

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13
Q

Describe the components of the prone neonatal exam

A

Hold baby prone perpendicular to arm- does baby hold itself rigid for a couple of seconds? Indicates normal tone
Check for sacral dimple/tufts of hair/port wine stain- indicates possible spinal bifida occulta
Skin changes- peau d’orange, masses, rashes

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14
Q

Describe the neonatal reflexes to check

A

Grasp
Root
Suck
Pull to sit- hold baby forearms, lift up- at past 80 degrees head should fall forward
Moro- hold baby’s head in palm, drop arm down from 80-20 degrees quickly
- Normal response is symmetric arm abduction and extension, then back to midline
- Abnormal may suggest brachial plexus palsy (Erb’s/clumpkies) or clavicle plexus

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15
Q

Causes of acute abdominal pain

A 
IBD
Appendicitis
Henoch-Schonlein purpura
UTI
Constipation
Bowel obstruction
Gastroenteritis
Intussusception
Diabetes
Lower lobe pneumonia
Peptic Ulcer
Renal stone
Ovarian torsion/cyst/ectopic
Volvulus
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16
Q

Causes of recurrent abdominal pain (categories)

A 
Hepatitis
Gastrointestinal
Urinary
Pancreatitis
Gynaecological
Psychogenic
Abdo migraine
Sickle cell disease
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17
Q

Features of IBD on history

A

Acute abdo pain
Blood or mucus in stools
Weight loss and poor stools
FHx of diarrhoea

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18
Q

Features of acute apendicitis

A 
Acute abdo pain
Anorexia
Pain localises to RIF
Peritonism in RIF
Tachycardia
Low grade fever
Vomiting and diarrhoea
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19
Q

Features of Henoch-Schonlein purpura

A

Acute abdo pain
Purpuric rash on legs
Joint pain

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20
Q

Features of UTI on history

A 
Abdo pain
Dysuria and frequency
Bedwetting
Back pain
Vomiting
MSU/microscopy is positive
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21
Q

Features of constipation on history

A

Abdo pain
hard or infrequent stools
Mass in LIF
Faecal loading on radiograph

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22
Q

Features of intestinal obstruction on history

A

Abdo pain
Bile stained vomiting
Abdo distension
Consider volvulus

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23
Q

Features of gastroenteritis on history

A

Abdo pain

Vomiting and diarrhoea

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24
Q

Features of renal calculi on history

A

Abdo pain

Hydronephrosis

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25
Features of peptic ulcer on history
Abdo pain Pain at night Relief with milk Helicobacter pylori
26
Features of lower lobe pneumonia on history
Abdo pain Signs of pneumonia Referred abdominal pain
27
Features of diabetes on history
Abdo pain | Diabetic ketoacidosis
28
Features of intussusception on history
``` Abdo pain Intermittent screaming/colic Shock/pallor Redcurrant jelly stool is a late sign 3-24mo old Often following a viral infection Palpable sausage shaped mass ```
29
Ix for appendicitis
Bloods- leukocytosis, neutrophilia Urine to exclude UTI CT if in doubt
30
Mx for appendicitis
Laparoscopic appendectomy If perforation- may be adhesions etc. ABX
31
Ix for intussusception
- Abdominal radiograph- may show proximal bowel obstruction, edge of intussusception against gas filled lumen - USS- Shows 'donut sign'
32
Mx for intussusception
- Often reduced by air or barium enema | - If evidence of peritonitis- laparotomy
33
Features of volvulus
Torsion of malrotated intestine Severe abdo pain and bilious vomiting Urgent surgery to untwist
34
Mechanism of mesenteric adenitis
Enlarged mesenteric nodes cause acute pain but no peritonism or guarding
35
Mx of mesenteric adenitis
Simple analgesia
36
Types of chronic abdo pain due to GI causes
``` IBS Oesophagitis Peptic ulcer IBD Constipation Malabsorption Giardiasis ```
37
Types of chronic abdo pain from urinary tract
Lower UTI | Pyelonephritis
38
Types of chronic abdo pain from gynaecological
Dysmenorrhoea PID Haematocolpos Ovarian cyst
39
Features of IBS
Recurrent abdo pain Bloating Altered bowel habit May have alternating diarrhoea and constipation
40
Dx of IBS
Symptoms must be present for 6mos | Requires an organic cause to be excluded
41
Mx of IBS
Acute symptoms resolve May need re-evaluation of diagnosis Smooth muscle relaxants may help spasms
42
Causes of vomiting
``` Overfeeding GORD Pyloric stenosis Whooping cough SBO Constipation Systemic infection Early pregnancy (older females) Ingestion of toxins Raised ICP Migraine Gastroenteritis ```
43
Features of overfeeding causing vomiting
Feeding >200mL/kg/day
44
Features of GORD causing vomiting
Due to lax GO sphincter and may see positional vomiting May lead to oesophagitis or aspiration pneumonia Can see apnoea or failure to thrive
45
Features of pyloric stenosis causing vomiting
``` 4-6 weeks old Projectile vomits after feeding Hungry after vomiting Less frequent stools Palpable pyloric mass ```
46
Features of whooping cough causing vomiting
Paroxysmal cough, red or blue colour change and then vomit
47
Features of SBO causing vomiting
Bile stained vomit Presents soon after birth May show a distended abdomen
48
Causes of diarrhoea in children
``` Toddler's Diarrhoea Nonspecific Diarrhoea Cystic fibrosis Coeliac disease Secondary lactose intolerance Overflow diarrhoea UC Lactose intolerance Crohn's disease Giardia ```
49
Features of toddler's diarrhoea on history
- Thriving toddler - Loose stools containing undigested food - May have large fluid intake - Fast gut transit time
50
Features of nonspecific diarrhoea on history
Loose watery stools | Thriving child, may follow after acute gastro
51
Features of giardia infection
Weight loss and abdominal pain Watery stools Common in nurseries
52
Features of crohn's disease on history
Late childhood/adolescence Weight loss and abdominal pain Anorexia and fatigue Exacerbations and remissions
53
Features of cows milk protein intolerance
Occurs in babies Watery stools that may be bloody May also show urticaria, stridor, bronchospasm or eczema
54
Features of UC on history
Late childhood and adolescence Bloody stools and abdominal pain Exacerbations and remission
55
Features of overflow diarrhoea in constipation
Soiling rather than diarrhoea | Constipated stool may be palpable abdominally or rectally
56
Features of secondary lactose intolerance on history
Baby or toddler Follows acute gastro Watery stools with low pH and reducing substances
57
Features of coeliac disease on history
Failure to thrive with irritability, muscle wasting, abdo distension Often presents after introduction of wheat into diet Fatty stools Diagnosed on jejunal biopsy
58
Features of cystic fibrosis on history
Starts in infancy Failure to thrive with chest infections Fatty stools Diagnosed with sweat test
59
Mx of secondary lactose intolerance
Empirical formula change to soy or lactose free milk | Revert to cows milk after symptom resolution
60
Ix for coeliac disease
Iron deficiency anaemia Steatorrhea IgA tTGA2 present in blood Definitive diagnosis with villous atrophy on jejunal biopsy
61
Mx of coeliac disease
Gluten free diet indefinitely | Repeat challenge and biopsy at 2 years
62
Assoc with coeliac disease
Diabetes | Down syndrome
63
Dx of crohns disease
Endoscopic biopsy
64
Mx of crohns disease
``` Elemental diet Immunodulator drugs Anti- TNF-a (infliximab) Steroids Surgical resection if localised ```
65
Mx of UC
Oral or rectal mesalazine or steroid enemas | May require immunosuppression, infliximab or colectomy if severe
66
Dx of giardia
Microscopic stool examination over 3 seperate specimens | May also have eosinophilia on bloods
67
Mx of giardia
Metronidazole

Clinical Medicine (5 decks)

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