PAEDS 2 Flashcards by Eira Hegarty

Manipulation technique for a pulled elbow:

Hold elbow, extend and pronate.

More successful and less painful than other option of flex and supinating.

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When should you refer a greenstick fracture to ortho?

> 20 degrees of angulation

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What defines a greenstick fracture?

UNILATERAL cortical breech (kids bones are ‘bendy’)

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What defines a buckle fracture, and buckle fracture managment?

incomplete cortical disruption, with periosteal haematoma causing swelling

Often no surgical intervention, often splinting and immobilisation without a cast is all that is needed.

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Classic triad of symptoms in intussusception, though the triad is only present in 20% of patients, so must have a high index of clinical suspicion.

Redcurrant jelly stool

Bloody stool

Intermittent abdominal pain

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Most common cause / association of intussusception:

Meckel’s diverticulum

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First line investigation for intussusception, and what would be visualised?

Ultrasound

Target sign
Doughnut sign

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When is an air enema contraindicated in suspected intussusception?

Cannot do if delayed presentation

Risk or evidence of perforation, ischaemia, peritonitis.

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At what ages should paediatric inguinal hernias be repaired a) urgently b) electively

Early months e.g. 2-3. Most chance of strangulation. Urgent repair.

> 1 year can be elective.

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Discuss criteria for immediate CT head in children presenting after a head injury:

Dangerous mechanism of injury
Signs of basal skull fracture
GCS <14, or <15 in baby
Suspected NAI
3 or more vomits
LOC >5 mins witnessed
Drowsy
Amnesia >5 mins
Seizure no prev epilepsy
Open / depressed skull #
Tense fontanelle

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An AXR is performed in a child with Trisomy 21, bilious vomiting and abdominal distension. It shows the ‘double bubble’ sign - what is the diagnosis?

Duodenal atresia

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Give 2 other gastrointestinal abnormalities associated with duodenal atresia / Trisomy 21.

Tracheoesophageal fistula

Hirschsprung’s disease

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Tests associated with predicting Down’s syndrome antenatally:

beta-hCG 1st trimester

PAPP-A in conjunction with maternal age

Nuchal translucency US

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Important conditions screened for on the neonatal blood spot test (5-8 days old):

Cystic Fibrosis
Sickle-cell
PKU
Homocysteinuria
Congenital hypothyroidism

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Most common congenital heart defect in children with Trisomy 21.

AVSD

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Weight schedule for newborns if no concerns:

Monthly for 6 months

2 monthly 6-12 months

3 monthly until 2 years

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2 common causes of delayed gross motor development:

Duchenne Muscular Dystrophy

Cerebral Palsy

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Why may a child complain of bone pain in leukaemia?

Increased pressure inside the bone marrow from hyperplastic marrow.

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Outline the investigations in suspected leukaemia in a child.

FBC; anaemia, thrombocytopenia, leukopenia

Blood film - blasts

CXR - mediastinal lymphadenopathy

Bone marrow trephine and aspiration

Symptoms of leukaemia, related to bone marrow failure:

Fatigue, breathlessness, pallor

Bleeding, bruising

Infection, fever

Poor prognostic indicators in ALL:

<1 years / >10 years

T-cell lineage

WCC >50 at presentation

Chromosomal abnormality e.g. Philadelphia 9:22

Refractory to induction therapy

Most common organism in paediatric endocarditis?

Strep viridans

If a patient with cystic fibrosis were to present in the neonatal period, what would the most common presenting feature be?

Meconium ileus

AXR of Hirschsprung’s disease would show:

Narrowing of part of bowel (aganglionic segment) with a clear transition zone to normal bowel segment.

When is the combined test for Trisomy 21 done?

11-13+6 weeks

Why would NIPT be offered during pregnancy?

If combined / quadruple screening returned a 'higher chance' result

Combined and quadruple test results for Trisomy 21:

hcg high PAPP-A low nuchal translucency thickened AFP, unconj oestriol low hcg and Inhibin A high

4 components of the quadruple test, which is offered to women who book in later and done at 15-20 weeks.

AFP Unconjugated oestriol HCG Inhibin A

How do the results for Trisomy 21 and Edward's/Patau's syndrome differ in the combined test?

Similar, but hcg tends to be LOW not high

Describe formation of conj and unconj bilirubin and key differences between the 2:

Hb breakdown -> unconjugated bilirubin, not soluble -> liver conjugates it -> conj bilirubin is soluble Unconjugated bilirubin can cross the BBB

Physiological mechanism of action of phototherapy in jaundice:

Breaks down bilirubin into water soluble isomer for excretion

Some causes of neonatal jaundice:

HDN G6PD deficiency Biliary atresia Breast milk jaundice Bruising from traumatic delivery Hypothyroidism Congenital spherocytosis

Which neurological reflex is 'abnormal' in a newborn and why?

Babinski - 'upgoing' is normal in neonates

Common conditions of extreme prematurity (5):

RDS IVH NEC Retinopathy of the newborn (<32w) Chronic lung disease

3 hour old baby with respiratory distress. 5 potential respiratory causes:

TTN RDS Pneumothorax Congenital pneumonia Pulmonary hypoplasia

Risk factors for EOS neonatal sepsis:

Pre-term PROM GBS maternal infection Maternal infection during labour / chorioamnionitis

Complications / long term effect of spina bifida:

Walking difficulties Neuropathic bladder Faecal incontinence Learning difficulties Bulbar symptoms Seizures Scoliosis

Best test for diagnose possible underlying cause of obstruction in neonates?

Upper GI contrast study

5 aspects of the APGAR scoring system:

Activity Pulse Grimace Appearance Respiratory

5 complications of phototherapy treatment:

Dry skin / skin rash Dehydration Diarrhoea Eye irritation from blue light Disrupted breast feeding establishment

4 long term sequelae of kernicterus:

sensorineural deafness dystonic / choreoathetoid CP Learning difficulty Seizure

?Pathophysiology of retinopathy of prematurity

Increased oxygenation e.g. in NICU, leading to proliferative retinopathy / neovascularisation

Meckel's diverticulum is a congenital diverticulum of the small intestine. What is it a remnant of, what does it contain, and though it is normally asx, how might it present?

Remnant of omphalomesenteric / vitelline duct. Contains ectopic ileal (or gastric or pancreatic) mucosa. Abdominal pain similar to appendicitis, also rectal bleeding, can be massive. Intestinal obstruction due to omphalomesenteric band, or volvulus or intussusception.

Type of scan used in Meckel's?

99 technetium pertechnate, high affinitiy for gastric mucosa

2 types of congenital visceral malformations:

Gastroschisis Omphalocele / exomphalos

What does gastroschisis describe? How should this baby be delivered?

Congenital defect within abdominal wall, abdominal contents out. Can be delivered vaginally but should go to theatre within 4 hours of delivery.

What does exomphalos / omphalocele describe? How should this baby be delivered?

Bowel and other organs within an amniotic sac. CS should be done. Staged repair as often there is a lack of space and high intra-abdominal pressure.