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Paeds > Paeds 3a > Flashcards

Paeds 3a Flashcards

1
Q

Detail the paediatric immunisation schedule

A

2 MONTHS

  • 6 in 1
  • rotavirus
  • PCV
  • men B

3 MONTHS

  • 6 in 1
  • rotavirus

4 MONTHS

  • 6in 1
  • PCV
  • MenB
1 YEAR
-Hib/ MenC
-MMR
PCV
Men B

2-8 YEARS OLD
-flu vaccine

3 YEARS 4 MONTHS

  • DTP/P
  • MMR

GIRLS 12-13
-HPV

14 YEAR OLD

  • DTP
  • Men ACWY
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2
Q

what is screened for in the Guthrie test

When is the Guthrie test carried out?

A

Guthrie test- 5-8 days

  • congenital hypothyroidism
  • sickle cell disorders
  • CF
  • 6 inherited metabolic disorders- PKU, MCADD, maple syrup urine disease, isovolaemic aciduria, homocysinuria, glutaric aciduria
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3
Q

how will a left to right shunt congenital heart disease present and what are the common causes?

A

Breathlessness

  • VSD
  • PDA
  • ASD
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4
Q

how will a right to left shunt congenital heart disease present and what are the common causes?

A

cyanotic

5Ts
Truncus arteriosus
Transposition of the great arteries
tricuspid atresia
tetralogy of fallot
TAPVC
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5
Q

what type of congenital heart disease is common in Downs syndrome?

Signs?

A

Ventricular septal defect

pansystollic murmur
palpable thrill left sternal edge
pulmonary hypertension
Heart failure after 1 week if large

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6
Q

Which congenital heart disease?

Continuous machine murmur

treatment?

A

PDA

NSAIDs to close duct

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7
Q

List the features of tetralogy of fallot

A

Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Vental septal defect

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8
Q 
which congenital heart defect is associated with each genetic condition?
Williams
Turners
Downs
Marfans
A

Williams- aortic stenosis
Turners- coarctation of the aorta
Downs- ASD/ AVSD
Marfans- aortic regurgitation

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9
Q

How does heart failure present in infants?

A

Breathlessness on exertion- on feeding

FTT, tachypnoea, tachycardia, sweating, poor feeding, recurrent chest infections, murmurs

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10
Q

Difference between stridor and wheeze

A

Stridor- upper resp tract obstruction, inspiratory wheeze

Wheeze- end expiratory polyphony, lower respiratory tract obstruction

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11
Q

presentation of croup

common causative agent

treatment

A

<6yo, barking cough, stridor, hoarseness
worse at night
recent fever

red flags: drowsy, cyanosis, altered consciousness–> respiratory distress

cause: RSV or parainfluenza

Treatment: dexamethasone
adrenaline nebuliser if respiratory distress

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12
Q

epiglottitis presentation

cause

management

A

2-7yo, sudden onset continuous stridor, child unable to speak or swallow, drooling, little/no cough, muffled voice, respiratory distress, toxic and fever

HiB

Get anaesthetist to intubate
IV cefotaxime

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13
Q

Bronchiolitis presentation

cause

management

prophylaxis

A

1-9 months old
coryzal, cough, wheeze, fever, tachypnoea, inspiratory crackles, poor feeding, tracheal tug, cyanosis on feeding

CXR shows hyperinflated lungs

RSV

Management:
most sent home- supportive treatment
humidified oxygen, NG feed, fluids if neccessary,
bronchiodilator nebs

Prophylaxis
Palivizumab

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14
Q

Whooping cough presentation

Cause

Diagnosis

Management

A

infants
inspiratory whoop, bouts of coughing ending in vomiting, worse at night, cyanosis, apnoea
Prolonged cough >2weeks
epistaxis (nose bleeds) and subconjunctival haemorrhage

Bordetella pertussis

diagnosis with PCR nasal swabs

management
NOTIFIABLE DISEASE
azithromycin +/- erythromycin if >1 mo cough
if severe admit and isolate
vaccinate patient and contacts
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15
Q

Describe the pathology of asthma

A

chronic inflammatory disorder causing reversible airway obstruction

  • Bronchospasms
  • mucosal swelling
  • inflammation
  • increased mucus production
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16
Q

diagnosis of asthma

A

clinical symptoms
Fev1:FVC <70%
bronchodilator reversibility

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17
Q

management of asthma

A

STEPWISE

1) inhaled SABA PRN- Beta 2 agonist eg salbutamol
2) inhaled steroid daily- low dose bethamethasone
3) add LABA- salmetarol
4) increased steroid dose
5) oral steroid- prednisolone

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18
Q

acute asthma attack management

A 
Escalate as neccessary:
ABCDE
High flow O2
salbutamol nebuliser
IV hydrocortisone/ prednisolone
IV magnesium sulphate
Ipratropium bromide nebuliser
IV aminophylline
HDU
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19
Q

cystic fibrosis gene defect and diagnosis (x3)

A

autosomal recessive defect of CTFR gene on Ch 7

Diagnosis:

  • Gutherie heel prick- raised immunoreactive trypsinogen
  • sweat test- raised chloride ions
  • low faecal elastase
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20
Q

presentation fo CF in infancy

A 
meconium ileus (vomitting, abdo distension, failure to pass meconium)
FTT
steatorrhoea
malabsorption
recurrent chest infections
prolonged neonatal jaundice
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21
Q

name a mucolytic drug

A

carbocysteine

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22
Q

<1yo
regurgitation, distress after feeds, apnoea, aspiration pneumonia, FTT, food aversion, infant ‘spells’- seizure like, haematemesis

Investigations to diagnise

A

GORD

Investigations:
sometimes endoscopy and measure pH
PPI test- give antacids + symptoms improve

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23
Q

presentation of pyloric stenosis

metabolic disturbance

A 
2-7 weeks of age
males>females
PROJECTILE VOMMITTING- increasing frequency and force. Not bile stained, no diarrhoea
hunger
weight loss

Hypochloraemic, hypokalaemic metabolic alkalosis

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24
Q

diagnosis and management of pyloric stenosis

A

diagnosis
-test feed and ultrasound- see L–>R peristalisis and olive shaped pyloric mass

management

  • IV fluids
  • pyloromyotomy
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25
Q

intersussuption presentation

A

3mo-2 years boys>girls

paroxysmal abdo colic pain, knees drawn up to chest, pale, screaming in pain
vomiting- may be billious
mucus and blood in stools- RED CURRENT JELLY STOOL
RUQ abdo mass- SAUSAGE SHAPED

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26
Q

Intersussuption investigations and treatment

A

investigations

  • ultrasound abdo: doughnut shape
  • X ray: distended small bowel and absence of gas in large bowel

Treatment
Fluid resus
rectal air enema
surgical intervention

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27
Q

Necrotising enterocolitis presentation

Management

A

PREMATURE BABIES
1st few weeks of life
abdo distension, pain, fresh blood in stools, billous vomitting, feeding intollerance
risk of progressing quickly to abdominal discolouration, perforation and peritonitis.

fed with cows milk increases risk

Xray showing gas in gut wall pathomneumonic= pneumatosis intestinalis
also asymetrical dilated bowel loops, bowel wall oedema

MANAGEMENT
Stop feeding, Abx, parenteral nutrition, surgery if perforation

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28
Q

Presentation of coeliac disease

Diagnosis

Management

A

= gluten intollerance causing enteropathy (villous atrophy and crypt hyperplasia)–> malabsorption

2yo, failure to thrive following introduction of cereals into diet
general irritability, diarrhoea, abdo distension and buttock wasting, anaemia

DIAGNOSIS
Jejunal biopsy- flat mucosa
gluten withdrawal–> symptom resolution
Serological tests- IgA and endomysal antibodies

Gluten free diet

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29
Q

Presentation of Hirschsprungs disease
presentation

Investigation

A

=congenital absence of ganglia in segment of colon- poor innervation of bowel

CONSTIPATION
failure to pass meconium within 48 hours of life
older children- abdo distension and constipation

common in DOWNS and M>F

investigations
PR exam- causes explosive discharge of stool and gas

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30
Q

List some causes of jaundice

a) in first 24 hrs of life
b) 24hrs-2weeks of life
c) Prolonged

A

<24 HOURS

  • haemolytic disorders- rheusus (coombes test +ve)
  • congenital infections- syphilis, herpes, rubella

24 HOURS- 2 WEEKS

  • physiological- as fetal RBC lifespan shorter than adults and hepatic bilirubin metabolism less efficient
  • breast milk jaundice

PRLONGED- SERIOUS

  • infection-sepsis
  • hypothyroidism
  • billary atresia
  • CF
  • Hepatitis
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31
Q

complication of jaundice

A

Kernicterus
Bilirubin crosses blood brain barrier–> deposited in basal ganglia- neurotoxic- encephalopathy

seizures, learning difficulties, cerabal palsy, death

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32
Q

Signs of dehydration

A

sunken fontanelle, decreased consciousness, eyes sunken, tearless, dry mucosal membranes, decreased CRT, tachypnoea, tachycardia, low BP, low tissue turgor, oliguria

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33
Q

Management of dehydration formulas for children

A

RESUSITATION
20mls/kg of 0.9% NaCl

CORRECTION OF DEHYDRATION
% dehydration x weight x 10
dehydrated= 5%= 50mls/kg
shocked= 10%= 100mls/kg

MAINTENANCE FLUIDS
100mls/kg for 1st 10 kgs
50mls/kg for next 10 kgs
20mls/kg 20kgs+

add correction and maitenance fluids for amount per 24 hours–> give as vol/hr

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34
Q

Which fluid to use?

A

0.45% sodium chloride + 5% dextrose
or 0.9% sodium chloride + 5% dextrose

if hypoglycaemic- 10% dextrose 2mls/kg stat

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35
Q

Neonate- which fluid to use and formulas

A

10% dextrose (no saline)

Days old:
1- 60 mls/kg/day (think like 1 hour)
2- 90mls/kg/day
3- 120mls/kg/day
4+ 150mls/kg/day
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36
Q

Most common cause of UTI in children

A

E.COLI
klebsiella
proteus

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37
Q

Investigations of a UTI

A

urine analysis- raised nitrites and leucocytes
urine microscopy
ultrasound- structural abnormalities?
DMSA- shows renal scarring of vesoureteric reflux

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38
Q

Treatment of UTI

A

<3 months
IV amoxicillin + gentamycin

> 3 months
trimethoprim/ nitrofurotonin/amoxicillin

39
Q

Presentation of nephrotic syndrome

Cause

Management

A 
aged 2-5
nephrOtic 
-prOteinuria
-Oedema
-hypOalbuminaemia
-hyperlipidaemia

facial, scrotal/vulval, periorbital oedema, ascities
Frothy urine, recurrnent infections, fatigue, malaise

80% caused minimal change disease

MANAGEMENT
-if minimal change- Prednisolone oral 60mg/m2

40
Q

Haemolytic uraemic syndrome presentation

Investigations

Management

A

most common cause of AKI in children

<3yo
prodrome of bloody diarrhoea- E.coli
triad of
-acute renal failure
-thrombocytopaenia
-microangiopathic haemolytic uraemia

investigations
FBC and film- fragmented red blood cells- burr cells
U+Es- renal functioning
Stool culture

Management
SUPPORTIVE- not antibiotics
fluid and electrolyte management

41
Q

Presentation of Henoch-schonlein purpura

A

IgA mediated small vessle vasculitis
Seen in children following an infection- usually URTI
4-6yo

  • palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
  • abdominal pain
  • polyarthritis
  • features of IgA nephropathy may occur e.g. haematuria, renal failure
42
Q

what are the 4 areas of development assessed

A

1) gross motor
2) fine motor and vision
3) speech and language
4) social

43
Q 
What are some developmental milestones at
6 weeks
6months
9months
12 months
18 months
2 years
3 years
4 years
5 years
A

6 weeks- smiles, stabilises head, eyes track movement
6 months- sits unsupported, palmar grasp, babbles
9 months- crawls, pincer grip, waves bye bye, aware of strangers
12 months- walking, one or two words, understands multiple words
18 months- run, scribbles, 6-12 words
2 years- puts words together in sentences
3 years- draws a circle
4 years draws a square
5 years- hops, throw and catch, count to 10

44
Q

What are the primitive reflexes and when should they be grown out of?

A 
Moro (drop head, arms fling out)
Palmar and plantar grasp
atonic neck reflex
rooting
stepping

grow out by 6 months

45
Q

Risk factors of cerebral palsy

A

preterm birth, twins, maternal infection, difficult delivery, vascular occulsion antenatally, meningitis, head trauma, encephalitis, hypoglycaemia

46
Q

Autism presentation

A 
communication and language impairment
impairment of social relationships
ritualistic and compulsive phenomenon
hypersensitivty
poor imagination
47
Q

Core behaviours of ADHD

Management

A

Hyperactivity, inattention, impulsivity

Methylphenidate/ atomoxetine/ dextroampheamine

48
Q

Describe the presentation of each seizure + appropriate management

tonic-clonic
absence
West syndrome/ infantile spasms
myclonic
status epilepticus
juvenile myoclonic seizure
febrile convulsion
A

TONIC CLONIC
-limbs stiffen then jerk, LOC–>Valporate

ABSENCE
-brief pauses, eyes roll up, unaware, brought on by hyperventilation (windmill test)–>ethosuxamide (carbamazepine contraindicated

INFANTILE SPASMS
5months, head nodding, arm jerk, eeg shows hypsarrythmia, associated with progressive mental handicap–> prednisolone

MYOCLONIC
suddenly thrown to ground–> valporate

STATUS EPILEPTICUS
>5 mins, not regaining consciousness–> ABCDE, bucal midazolam/lorazopam, recovery postion, give O2

JUVENILE MYOCLONIC SEIZURE
G>B, aged 8-16yo, clumsy in the morning, myoclonic, tonic clonic and absence seizures, worse when tired–>valporate/ lamotrigine

FEBRILE CONVULSION
Single tonic-clonic symetrical generalised seizure lasting <15 mins, high fever, normal developing child 6mo-5 years–> if >5 mins give IV lorazepam. Unlikely to lead to epilepsy

49
Q

Name 2 diagnostic antenatal genetic tests

A

chorionic villous sampling
done at 11-13 weeks
placental biopsy of fetal cells
2% risk of miscarriage

amniocentesis
15-20 weeks
amniotic biopsy
1%risk of miscarriage

50
Q

List some autosomal dominant diseases

A

usually structural proteins

Huntingtons, PKD, achondroplasia, marfan syndrome, osteogenesis imperfecta

50% chance of passing it onto kids

51
Q

List some autosomal recessive diseases

A

often metabolic

CF, sickle cell disease, congenital adrenal hyperplasia, thalassaemia, homocystinuria

52
Q

Presentation of duchenne muscular dystrophy and genetic inheritance pattern

A

x linked recessive

3yo boy, delayed milestones, poor mobility, climbing up legs with hards to stand up, hypertrophy of calf msucles, fatigue, raised CK

53
Q

Presentation of Downs syndrome

A

Trisomy 21

intellectual disability, stunted growth, round face, flat nasal bridge, epicanthic folds, brushfield spots om iris, small mouth and protuding tongue, small ears, single palmar crease, gap between toes, short neck

AVSD, visual and hearing problems, hypotonia, increased infections, early onset dementia

54
Q

Presentation of Edwards syndrome

A

trisomy 18

survival 15 days
digit overlapping, wide head, rockerbottom feet, heart and renal malfunction, small chin and head

55
Q

Pataus syndrome

A

trisomy 13

polydactylity
cleft lip and palate, heart defects, small eyes, global developmental delay

56
Q

presentation of turners syndrome

A

45 X

female, delayed puberty, webbed neck, amenorhoea, coarction of aorta, thyroid, horseshoe kidney, low set ears, ejection systolic murmur

Tx: growth hormone and oestrogen replacement therapy

57
Q

Tests for developmental dysplasisa of hip and risk factots

A

screen 6-8 week old babies
ortolani and barlow test- dislocation and subluxation?

risk factors
female, breech, FHx, 1st born, birth weight .5kg, twins

58
Q

Presentation of developmental dysplasia of hip

A

Painless limp, walk on toes on affected side, limited abduction when fully flexed, leg dragging

59
Q 
Differential diagnosis of limping child: typical presentation of
trauma
transient synovitis
septic arthritis
juvenile idiopathic arthritis
developmental dysplasia of hip
perthes disease
slipped upper femoral epiphysis
rickets
A
  • trauma- history diagnostic
  • transient synovitis- acute onset, viral infection, more common in boys aged 2-12yo
  • septic arthritis- unwell child, high fever
  • juvenile idiopathic arthritis- joint inflammation for at least 6 weeks, may be systemic (daily fever), psoriatic etc
  • developmental dysplasia of hip- usually detected in neonates, 6x more common in girls

Perthes disease- age 4-8. Avascular necrosis of femoral head

Slipped upper femoral epiphysis- 10-15yo, displacement of femoral head

rickets- vit D deficiency, bowing of legs, hypocalcaemic seizures, irritable and reluctant to weight bare, dark skin, poverty

60
Q

Presentation of respiratory distress syndrome

prevention

management

A

premature babies- surfactant deficiency

shortly after birth
increased work of breathing, tachypnoea >60/min), grunting, nasal flaring, intercostal recession, cyanosis
CXR shows ground glass appearance

Prevention: dexamethasone given to mothers at risk of preterm birth

management
O2, CPAP, mechanical ventilation
Surfactant therapy

61
Q

What is protective against necrotising enterocolitis in neonates

A

Breast feeding

cows milk increases risk

62
Q

give some risk factors of neonatal sepsis and likely causative agents

A

RISK FACTORS
maternal infection, PROM, mum group B strep carrier, preterm, fetal distress

ORGANISMS
ecoli, GBS, listeria, herpes simplex, chlamydia

63
Q

Presentation of hypoglycaemia in newborns

A

common in 1st 24 hours in premature

jittery, seizures, irritable, cyanosis, apnoea, hypothermia, drowsiness

nb prolonged hypoglycaemia can cause long term neurological damage
feed within 24 hours of birth and give IV glucose infusion if necessary

64
Q

Presentation of Measles

complications

Management

A

C
cough, coryza, conjunctivitis, koplick spots (white spots on buccal mucosa)
rash starting behind ears and spreading over whole body

complications
otitis media, croup, trachitis, encephalitis

management
symptomatic treatment
NOTIFIABLE DISEASE

65
Q

Mumps presentation, complications, management

A

fever, malaise, parotitis (facial swelling)
usually mild and self limitting

complications- orchitis, viral meningitis, encephalitis, hearing loss

management
symptomatic treatment
NOTIFIABLE DISEASE

66
Q

rubella presentation/ complications/ management

A

low grade fever
maculopapular rash on face
lymphadenopathy

dangerous in pregnancy- causes fetal cateracts, deafness, congenital heart disease

management
symptomatic treatment
NOTIFIABLE DISEASE

67
Q

Erythema infectosum= parvovirus

A

facial rash-slapped cheek
fever, headache, myalgia
rash progesses to maculopapular rash

complications rare in children. Spreads by droplet- increased in close communities

68
Q

roseola infantum

A

9-12months old
previous good health, sudden onset fever for 3 days, then rapid drop of fever, followed by mild pink maculopapular measles-like rash

supportive treatment

69
Q

varicella zoster virus

A

chicken pox, shingles is reactivation of dormant virus

fever, vesicular rash on head, spreads all over body. Papules-vesicles-pustules-crusts

very infectious

complications
secondary bacterial infection, encephalitis, pulpura fulminans, necrotising fasciitis

70
Q

kawasaki disease

management

complication

A

vasculitis
high grade fever >5 days
bright red cracked lips, red palms and soles that peel, strawberry tongue, conjunctival infection

MY HEART
M muscosal involvement (dry cracked lips and strawberry tongue)
H hands and feet oedema and desquamation
E eyes- non purulent bilateral conjunctivitis
A- adenopathy
R- rash
T- temp for more than 5 days

management
high dose aspirin- anti-inflammatory and antiplatelets
IV immunoglobulin- dampens immune response

complication
- coronary artery aneurism- do echocardiogram on admission and then at 5-6 weeks

71
Q

scarlet fever

management

A 
Staph pyogenes
sore throat, short fever, malaise
rough rash starting on neck, pinpoint dark red spots on general red area
area around mouth pale and face flushed
strawberry tongue

management
penicillin/ azithromycin

72
Q

common causes of meningitis in
neonates
older children and adults

A

NEONATES
ecoli
group B strep
listeria monocytogenes

INFANTS

  • strep pneumonia
  • h.influenzae
  • staph aureus
  • group A strep
  • Neisseria meningitidis
OLDER- NHS
Neisseria meningitidis
Haemophilus influenzae
strep pneumonae 
Group A strep
staph aureus
73
Q

management of suspected meningitis

close contact prophylaxis

A

<3months old
IV amoxicillin and cefotaxime

> 3 months cefotaxime

stabilise, dexamethason to prevent hearing loss and neurological impact

close contact prophylaxis- ciprofloxacin/ rifampicin

74
Q

Presentation of diabetes mellitus

A

age 5-7/ just before puberty

polyuria, polydipsia, lethargy, weightloss, infections, poor growth, ketosis

fasting >7mmol/L
Random > 11.1 mmol/L

75
Q

presentation of ketoacidosis

A 
listless, confusion, vomiting, polyuria, polydipsia, abdo pain
dehydration
kassmaul respiration- deep and rapid
ketotic- fruity smelling breath
shock- drowsiness-coma

increased risk of cerebral oedema

76
Q

management of ketoacidosis

A

IV fluids- 0.9% saline
-treat shock, then maintenance- give over 48 hours, if too fast increase risk of cerebral oedema

IV insulin after 1 hour of fluids

Monitor

77
Q

presentation of congenital adrenal hyperplasia

A

low sodium high potassium

girls- ambiguous genitalia,

adrenocortical crisis- circulatory collapse- early life, after stressor, seizures, nausea, vomitting, lethargy, hypotension

management with glucocorticoid and mineralocorticoid replacement

78
Q

Organisms causes pneumonia in neonates/ infants/ adolescents

A 
NEONATES
ecoli
klebsiella
group B strep
TB
infants
RSV
step pmeuminia
-h.influenza
-staph aureus
-chlamydia
-TB
ADOLESCENTS
-strep pneumonia
mycoplasm pneumonia
-staph aureus
-TB
79
Q

List the clinical features of Downs syndrome

A

face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small ears, round/flat face
flat occiput
single palmar crease, pronounced ‘sandal gap’ between big and first toe
hypotonia
congenital heart defects- AVSD (40-50%, see below)
duodenal atresia
Hirschsprung’s disease

80
Q

6 features of colitis

A 
diarrhoea
abdo pain
urgency
tenesmus
nocturnal stooling
mucus and blood
81
Q

causative organism of haemolytic ureamic syndrome

A

E.coli 0157

82
Q

investigations of diarrhoea

A

stool sample
urine sample
blood culture
faecal calprotectin - inflammatory bowel disease

83
Q

define failure to thrive

A

Significant interruption in the expected rate of growth compared with other children of similar sex,
and age. Cross over two centile lines on growth chart.

84
Q

give an example of

  • respiratory acidosis/ alkalosis
  • metabolic acidosis/alkalosis
A

respiratory acidosis- low pH, high CO2- severe asthma, decreased respiratory muscle ability

respiratory alkalosis- high pH, low CO2- anxiety, fear, altitude, salicylate poisoning

metabolic acidosis- low pH, low bicarbonate- shock, diarrhoa, ketoacidosis

metabolic alkalosis- high pH, high bicarbonate- eg vomiting, pyloric stenosis, cushings

85
Q

questions to ask when assessing control of asthma

A
  • number of hospital admissions
  • number of oral courses of steroids
  • how often using blue inhaler
  • ITU admissions?
86
Q

what should be done when discharge a child home after an acute asthma attack

A

check inhaler technique and compliance

87
Q

sepsis definition

A

life-threatening organ dysfunction caused by a dysregulated host response to an infection

88
Q

outline the management of paediatric sepsis

A

1) airway management and temp control
- intubate if necessary
- oxygen if <94%

2) IV access and take bloods

3) IV fluids- 20mls/kg bolus as necessary
- maintenance fluids

4)broad spectrum antibiotic eg cefotaxime

5) appropriate escalation as necessary
- inotropes (dopamine, adrenaline, noradrenaline
- cardiac output monitoring
- further fluid balance maintenance

  • blood transfusion
  • corticosteroids
89
Q

Most common child hood malignancy

Presentation

A

Acute lymphoblastic leukaemia
2-5 yo
bone marrow failure

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
testicular swelling

90
Q

presentation of neuroblastoma

A

a solid tumour that arises from the developing sympathetic nervous system
children <5 yrs
usually late- symptoms often due to mass effect or mets

-abdo mass, pallor, weight loss, bone pain, limp, hepatomegaly, paraplegia, proptosis Periorbital bruising - ‘racoon eyes’, constipation, blue-ish lump on neck, jerky eye and muscle movements

91
Q

Presentation of wilms tumour

A

Most common intra-abdominal tumour in childhood
undifferentiated mesodermal tumour of the intermediate cell mass- nephroblastoma

abdominal mass (most common presenting feature)
painless haematuria
flank pain
other features: anorexia, fever
unilateral in 95% of cases
metastases are found in 20% of patients (most commonly lung)

associated with Beckwith-Wiedemann syndrome

92
Q

list some causes of neonatal collapse

A 
sepsis
duct dependent circulation
persistent pulmonary hypertension of newborn
metabolic emergency- hypoglycaemia/ CAH
trauma/ non-accidental injury
93
Q

presentation of GORD

management

A

infancy <1yo

regurgitation (non forceful vomitting after feeds)
distress after feeds, apnoea, pneumonia, FTT, haematemesis, anaemia

conservative
-feed thickening, upright posture, avoid overfeeding

medical
-PPI, renitidine (H2 receptor antagonist), antacids

Paeds (1 decks)

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