Paeds

Question 1

Normal resp rate for:
Term-3 mo
4-12mo
1-4yrs
5-12yrs
12yrs+

Answer 1

Term-3 mo: 30-60
4-12mo: 30-40
1-4yrs: 20
5-12yr: 16
12yrs+: 16

Question 2

HR MET criteria for: 
Term-3 mo
4-12mo
1-4yrs
5-12yrs
12yrs+

Answer 2

Term-3 mo: <100 >180
4-12mo: <100 >180
1-4yrs: <90 >160
5-12yrs: <80 >140
12yrs+: <60 >130

Question 3

Normal signs of respiration in young children (4)

Answer 3

Chest in-drawing
Periodic respiration (not constant rate) BUT NO APNOEA
Incr rates of resp

Question 4

Definition of apnoea in newborns

Answer 4

No respiratory effort for greater than 20 seconds.
No respiratory effort for shorter periods of time may also be classified as apnoea if accompanied by cyanosis or bradycardia

Question 5

Causes of the following types of tachypnoea:
• Expiratory wheeze (lower airway obstruction with asthma, bronchiolitis)
• Exhaling with a closed glottis (pneumonia)
• Stridor (upper airway obstruction)
• Effortless (DKA)

other

Answer 5

• Expiratory wheeze (lower airway obstruction with asthma, bronchiolitis)
• Exhaling with a closed glottis (pneumonia)
• Stridor (upper airway obstruction)
• Effortless (DKA)

Other: anaemia, fever, cardiac failure, CNS pathology

Question 6

Most common causes of bradycardia

Answer 6

Hypoxia MOST COMMON
Bradyarrhythmia
Drugs

Question 7

Causes tachycardia

Answer 7

Fever
Pain, Anxiety
Hypoxia, hypercarbia, Hypovolaemia
Anaemia
Arrhythmia, cardiac failure
Seizures
Drugs

Question 8

Causes of hypotension with

1. Wide PP
2. Narrow PP

Answer 8

1. Wide PP (120/20)
   - PDA
   - AR
   - Thyrotoxicosis
   - Anaemia
   - Sepsis
2. Narrow PP (70/50, weak thready pulse)
   - Hypovolaemia
   - Haemmhoragic shock
   - Severe dehydration
   - AS, coarctation of aorta

Question 9

24 hours of fever, lethargy and vomiting in child.

- primary diagnosis and management

Answer 9

Bacterial sepsis until proven otherwise!

• A: Protect airway (sit up/safety position;; NG tube; yankee sucker)
• B: Give O2 >5L/min
• C: Give Hartmann’s or saline
• BSLs
• Reassess
• ORder: Blood cultures, blood gas
• Prophylactic antibiotics
• Call reg and PET service

Question 10

Lump in children - what are the 3 main differential categories?

Answer 10

1. Congenital
2. Inflammatory
3. Cancer

Question 11

What is exomphalos?

What about this kills babies?

Answer 11

Exomphalosis a weakness of the baby’s abdominal wall where the umbilical cord joins it. This weakness allows the abdominal contents, mainly the bowel and the liver to protrude outside the abdominal cavity where they are contained in a loose sac that surrounds the umbilical cord.

It is the evaporative heat loss leading to hypothermia that kills babies

Question 12

What is the most common DDX for a lump on the eyebrow at birth
Treatment

Answer 12

Exoid dermoid cyst (developmental remnant)

Treatment is surgical excision

Question 13

How do you treat strawberry naevi

Answer 13

Propranolol accelerates their complete regression (would go away on their own by ~5 years)

Question 14

What are the signs of hydrocephalous in infants?

Answer 14

Macrocephaly
Sun setting eyes (can only see upper half of iris)
Bulging fontanelle
Seizures

Question 15

Causes of hydrocephalous in infants - what is the most common?

Answer 15

Congenital

Acquired

• Most common is medullary blastoma in 4th ventricle
• intraventricular haemmhorage
• SA haemmhorage
• meningitis
• SC lesion/tumour
• Traumatic head injury
• premature birth

Question 16

What are you worried about when you see an absent anal cleft?

Answer 16

Sacrococcygeal teratoma -> tumor on coccyx that eventually grows to fill out the anal cleft and can grow larger than the baby. Turns malignant peri-natally

Question 17

What is the functional consequence of cleft palate in babies?

Answer 17

Swallowing and sucking difficulties (can usually swallow but not suck)

Question 18

What is the significance of an enlarged Virchow’s node in children? What does it drain?
What differentials you think of ?

Answer 18

Virchow’s node only enlarged with cancers, not inflame conditions. Drains the thoracic duct.

Hodgkins (10-15 year olds) or Neuroblastoma (very young children)

Question 19

What is the most common anorectal malformation in females?

Symptoms

Answer 19

REctovestibular fistula. Abnormal connection between vagina and the rectum.

Symptoms: Gas, faeces, pus passing through vagina

• Vulvar irritation, inflammation
• Gross smelling vaginal discharge
• Frequent UTIs
• Pain during sex if older

Question 20

Clinical features of malrotation

Answer 20

Early signs

• Bilious vomiting (flour green)
• Poor feeding

Late signs include: PR bleeding, abdominal distention and tenderness

Question 21

What causes malrotation?

Answer 21

Anatomical variation where base of mesentery is narrow which means DJ flexure and Ileocaecal flexure are next to each other, in RUQ which results in SHORT BASE OF MESENTERY and predisposes the mesentery to volvulus

Question 22

With malrotation, at what point does venous and arterial supply become compromised and when is best to intervene?

Answer 22

• If mesentery twists 360deg, venous and lymphatic supply are compromised resulting in bile-stained vomiting. Surgical intervention here has good outcome.
• If gut rotates further, arterial supply can become compromised -> intestinal ischaemia and infarction

Question 23

How do you diagnose malrotation?

What is the treatment?

Answer 23

Upper GI contrast study is gold standard - look for LOSS OF C-shaped duodenum to indicate malrotation

Or AXR changes: double bubble, gastric and proximal duodenal dilatation…

Urgent surgical referral and laparotomy -> LAdd’s procedure + appendicectomy

Question 24

Child with bile stained vomiting - diagnosis

Answer 24

Malrotation +/- volvulus until proven otherwise

Question 25

Non-bilious vomiting in neonates - differentials

Answer 25

Pyloric stenosis Infection - Sepsis, Meningitis, UTI Reflux Overfeeding

Question 26

Typical presentation of hypertrophic pyloric stenosis

Answer 26

PYLORIC STENSOSIS: Typically first born boys, with non-bilious projectile vomiting (vomit past their feet) after each feed who are HUNGRY after! - family history of HPS - visible gastric peristalsis +/- palpable pyloric tumour ('olive') if stomach isn't too distended

Question 27

When does pyloric stenosis typically present?

Answer 27

Peak 3-6 weeks old But can occur 10 days-11 weeks

Question 28

What metabolic derangements do you see in pyloric stenosis and why?

Answer 28

Due to profuse vomiting -> losing water, HCL, NACL, K Metabolic alkalosis Hypochloraemia Hypokalaemia Normal serum na Acidic urine (paradoxical change - kidneys conserve Na as compensation)

Question 29

What is intussception and what generally causes it?

Answer 29

Invagination of proximal into distal bowel - Peaks at 5-11 months - Physiological/idiopathic cause is most common (hypothesised that as babies wean, new antigen exposure causes payer's patches in terminal ileum to swell from inflammation and cause intussception) Less commonly can be due to pathological lead points

Question 30

Classic presentation of intussception

Answer 30

Crampy (intermittent, also known as colicky) Abdominal pain (infant pulls legs into stomach to relax abdo wall) Vomiting Bloody 'red currant jelly' stools (LATE sign) Sausage shaped mass in RUQ and emptiness in RLQ.

Question 31

What are 'anatomic' or 'pathological' lead points of intussception

Answer 31

Merkel's diverticulum Polyp Vascular malformation lymphoma

Question 32

Complications of intussception if not treated early

Answer 32

Bowel obstruction, | Ischaemia, perforation, shock

Question 33

How do you diagnose intussception?

Answer 33

Clinical suspicion -> US ('target sign') is first choice or AXR (?soft tissue mass ?absence of gas in caecal region)

Question 34

Treatment intussception

Answer 34

<48 hour history in otherwise stable child = air enema reduction >48 history or peritonitic/septic child = laparotomy

Question 35

Treatment pyloric stenosis

Answer 35

Fluid rehydration therapy and electrolyte replacement - 0.45% saline with 5% dextrose - Add K when baby is urinating Non-urgent surgical referral

Question 36

Treatment exompathalous

Answer 36

Place baby in humidicrib wrapped in glad wrap (ensure blood supply of exposed bowel isn't twisted/compromised) NGT for GI decompression Fluid resus Urgent T/F to tertiary centre

Question 37

DDX for acute scrotum (red, painful, tender scrotum) Immediate management

Answer 37

- testicular torsion - torsion of appendix testies - epididymo orchitis - idiopathic scrotal oedema Urgent surgical referral ?surgical exploration

Question 38

Classic presentation of appendicitis

Answer 38

Colicky periumbilical pain migrating to RLQ and becoming constant Assoc w : - anorexia - fever - nausea - d&v

Question 39

What are warning signs for appendicitis in kids?

Answer 39

abdo pain >24 hours diarrhoea >24 hours Infant preferring to lie still Suspected peritonitis if child doesn't allow abdo exam

Question 40

What group most commonly have atypical presentations of appendicitis and how do you diagnose it?

Answer 40

Kids <5 yo Adolescent girls Need U/S diagnosis - May need to do bloods (CRP, WCC), but bloods are NOT ROUTINE in kids.

Question 41

Long term effects of diptheria infection

Answer 41

Toxin causes nerve and heart damage | Mortality 1/15

Question 42

Long term effects of tetanus infection

Answer 42

Toxin causes nerve and muscle changes resulting in paralysis, convulsions Mortality 1/10

Question 43

Pertussis - effects of infection

Answer 43

Whooping cough. M&M highest in infants

Question 44

Poliomyelitis - effects on infection

Answer 44

Febrile illness followed by paralysis in many (may become permanent) Mortality 1/20

Question 45

HIB - effects of infection

Answer 45

Systemic infection - meningitis, epiglottitis, bone and joint infections Mortality 1/20

Question 46

MMR

Answer 46

Measles encephalitis 1/2000, mumps encephalitis 1/200

Question 47

Where to give vaccines to children?

Answer 47

• Children under 1 ○ Anterolateral thigh (if 3 vaccines given at once, space injections 2.5 cm apart with third vaccine in other thigh) • Children >1 ○ Mid-deltoid region of upper arm • NOT BUTTOCKS -> risk damage to sciatic nerve

Question 48

Side effects of vaccines

Answer 48

* Local superficial inflammatory response -> redness, swelling at injection site * Mild transient systemic SX (crying, irritability, mild fever, febrile seizures) * Measles may be followed by mild, transient measles like illness (fever and brief rash 7-10s post immunisation) * anaphylaxis is v rare

Question 49

What extra vaccines what an aboriginal/torres straight islander child receive?

Answer 49

BCG | Hep A vaccine

Question 50

Vaccines given at 2,4,6 months

Answer 50

DTPa (Diptheria, tetanus, whooping cough) HIB IPV (inactive polio vaccine) HBV PCV (13v pneumococcal conjucate) RV (Rotavirus)

Question 51

Vaccines given at 12 months

Answer 51

MMR (measles, mumps, rubella) HIB MenCCV

Question 52

Vaccines given at 18mo

Answer 52

VZV (chickenpox) MMR (measles mumps rubella) DTP

Question 53

Vaccines given at 4 years

Answer 53

DTPa (diphtheria, tetanus, pertussis) | Polio

Question 54

Vaccines given at 10-15years

Answer 54

DTPa (diphtheria, tetanus, pertussis) VZV (chickenpox #2) HPV

Question 55

Vaccines given at birth

Answer 55

HBV

Question 56

Pattern of generalised seizure vs focal seizure

Answer 56

Generalised: wide spread all over brain, symmetric activity bilaterally Focal: starts in localised area of brain, unilateral

Question 57

What is another term for focal seizure that is commonly used and how is this further classified based on consciousness?

Answer 57

Partial seizure - Simple partial seizure: consciousness intact (motor, somatosensory, visual/auditoary, autonomic, dysphasic) -Complex partial seizure (consciousness not intact)

Question 58

How are generalised seizures further classified?

Answer 58

Tonic clonic Absence Myoclonic Atonic, Tonic etc

Question 59

Do generalised seizures affect consciousness? Motor systems?

Answer 59

Yes, always involve consciousness AND motor manifestations!

Question 60

What is the definition of a seizure vs of epilepsy

Answer 60

Seizure: Transient occurrence of signs and/or SX due to abnormal, excessive or hypersynchronous neuronal activity in cerebral cortex Epilepsy: Tendency to have recurrent unprovoked seizures (2 or more AFEBRILE seizures)

Question 61

What types of seizures aren't included in the definition of epilepsies?

Answer 61

1. Single seizure events 2. Neonatal seizure 3. Febrile seizures 4. Acute symptomatic seizure (systemic illness, acute neurological insults)

Question 62

Investigations for seizures in children

Answer 62

EEG (+/- video monitoring) MRI if… ◊ Suspected underlying cerebral abnormality ◊ Significant developmental delay ◊ Abnormal neurological findings on exam ◊ History of prior ne◊ Poorly controlled seizures CT only if suspected stroke, increased ICP, traumatic brain injury (never perform in otherwise well child)

Question 63

Seizure mimics

Answer 63

○ Normal phenomenon § Sleep jerks § Tantrums § Inattention, day dreaming ○ Syncope and related episodes § Vasovagal § Breath-holding spells § Long QT syndrome ○ Parasomnias and related sleep disturbances § Night terrors, sleep walking, cataplexy, confusional arousals ○ Movement disorders § Tics, clonus, chorea, tremor ○ Behavioural and psychiatric disturbances § Mannerisms, psychogenic seizures, rage attacks ○ Migraine variants and NV episodes § TIA, complicated migraine, benign paroxysmal vertigo

Question 64

How can absence seizures be provoked?

Answer 64

hyperventilation

Question 65

what are febrile seizures often associated with? What ARENT they associated with?

Answer 65

Mostly assoc w URTI/UTI/viral exanthema Family history of seizures (30%) - same mutation in neuronal ion channel gene Age-limited predisposition to seizures (mostly 5mo-2yrs) NOT ASSOC W: CNS illness, prev afebrile seizure, incr mortality or later intellectual impairment

Question 66

Medications for epilepsy

Answer 66

Sodium valproate Carbamazepine Lamotrigine Ethosuximide

Question 67

DDX for generalised tonic clonic seizure (and what you would expect for each on history)

Answer 67

Focal seizure becoming generalised □ Preceding aura (note: NO aura with generalised TC) □ Todd's paresis (transient unilateral postictal weakness) □ Focal neurological deficits on exam □ HX of prior CNS illness/cerebral trauma Syncope □ Vasovagal setting □ Brief duration with rapid recovery Psychogenic seizure □ Eye closure during seizure □ Resistance to passive eye opening □ Intermittent or waxing and waning motor activity

Question 68

what broad category of seizure if there is limb jerking/head turning/stiffening that is UNILATERAL?

Answer 68

Focal seizure! Not generalised because must be in one hemisphere only.

Question 69

What type (lobe?) of focal seizure often gets confused for absence seizure?

Answer 69

Temporal lobe epilepsy

Question 70

What type of (lobe?) focal seizure features hyperkinetic autisms (tapping, cycling, running in place)

Answer 70

Focal lobe epilepsy

Question 71

Treatment of generalised vs focal epilepsies

Answer 71

Generalised seizures: Sodium valproate Focal: Carbamazepine

Question 72

What is the best method of measuring temp in children and what is the upper limit of normal (degC)

Answer 72

Electronic thermometer in axilla Axillary > 37.2C

Question 73

What is the definition of PUO?

Answer 73

Fever without focus for >2 weeks

Question 74

What are the 3 main causes of PUO

Answer 74

1. infection (?encapsulated bacteria) 2. autoimmune 3. malignancy

Question 75

What 3 main encapsulated bacteria infect kids

Answer 75

HIB Strep pneumonia Neisseria meningiditis

Question 76

What do you do if a child comes in with a fever?

Answer 76

``` If child is : > 3months non toxic fever <14 days It is likely viral so DON'T do septic screen (possibly check urine ex: if <6 months) and review to ensure they don't deteriorate. ``` Otherwise they get a septic screen

Question 77

What comprises a septic screen?

Answer 77

FBE, blood film Blood and urine cultures LP +/- CXR (if resp SX/signs)

Question 78

What questions to ask on HX when a child comes in with fever

Answer 78

``` Localising symptoms: cough coryza headache photophobia diarrhoea, vomiting abdominal pain joint symptoms ``` Travel history Sick contacts Immunisation hx

Question 79

SX, signs suggestive of a 'toxic' or unwell child

Answer 79

``` Lethargic Poor interaction Inconsolability Tachycardia, tachypnoea, Cyanosis, poor peripheral perfusion ```

Question 80

Presentation of meningococcus

Answer 80

Rapid onset Fever Flu-like SX (malaise, lethargy, vomiting, headache, myalgia, arthralgia) Confusion Rash (petechial/purpura) Photophobia Neck pain/stiffness

Question 81

Differentials for child presenting with fever and petechial rash (previously well, onset this am)

Answer 81

Meningococcus if unwell/shocked/toxic Viral infection (enterovirus, influenza) HSP ITP

Question 82

15 month old presents with a non-itchy blanching erythematous rash (not on face) following 3 days of sudden-onset high-grade fever and a single febrile seizure. What's your top differential? Treatment?

Answer 82

HHV6 (roseola) No treatment required - self limiting.

Question 83

Child presents with 'slapped cheek' rash on face and lacy rash on trunk and limbs following low-grade fever, malaise, or a "cold" a few days before the rash broke out. Differential? Treatment?

Answer 83

Parvovirus B19 No treatment required bc is viral +/- Paracetamol to bring down fever

Question 84

What is a rare complication of parvovirus B19 infection in pregnant women? How common is this?

Answer 84

If exposed to ParvovirusB19 in first half of pregnancy, baby can get fetal anaemia hydrops fetalis and fetal death (miscarriage) Occurs in 5% of pregnant women infected with parvovirus

Question 85

What are the clinical features of measles?

Answer 85

4 day infectious prodrome (3 Cs) preceding rash: Cough, coryza, conjunctivitis Fever Koplik's spots Rash (red, blotchy, starts on the head and then spreads to the rest of the body) - lasts ~7d

Question 86

2 year old with incomplete immunisations at creche with fever and cough, coryza, conjunctivitis progressing to descending, blotchy raised (papular) rash - diagnosis

Answer 86

Measles

Question 87

Management for measles

Answer 87

MMR vaccine (2 doses) within 72 hours of exposure if >9mo IVIG if <9mo or >9mo but >72 hours post exposure

Question 88

Differentials for diffuse erythematous rash (sunburn-like) in child

Answer 88

``` Toxic shock syndrome (Staph or strep) Scarlet fever/Invasive GAS Kawasaki disease Enteroviral infection Antibiotics ```

Question 89

what is the most severe complication of measles?

Answer 89

Encephalitis -> fatal in 15%

Question 90

What causes Scarlet fever?

Answer 90

Exotoxins from Group A Strep (pyogenies)

Question 91

What infections does GAS cause?

Answer 91

``` Scarlet Fever Pharyngitis Toxic shock Necrotising fasciitis Acute rheumatic fever GN ```

Question 92

Clinical presentation of scarlet fever

Answer 92

Exudative tonsillitis +/- pharyngitis Confluent erythematous sunburn-like rash Strawberry tongue Circumoral pallor

Question 93

Treatment of scarlet fever

Answer 93

Penicillin (oral) - to treat GAS

Question 94

What infectious agents cause toxic shock syndrome?

Answer 94

Exotoxins from staph aureus and strep pneumonia and strep progenies

Question 95

Features of Kawasaki disease

Answer 95

Fever>5 days (unresponsive to antibiotics) Polymorphous rash Bilateral non-exudative conjunctivitis Mucus membrane changes (oropharynx injected, strawberry tongue, swollen lips) Swollen erythematous hands and feet with eventual desquamation Unilateral cervical lymphadenopathy >1cm

Question 96

Treatment of kawasaki disease

Answer 96

IVIG and low-dose aspirin

Question 97

Complication of kawasaki disease

Answer 97

Coronary artery disease (aneurysm) | Higher risk of IHD

Question 98

Features of infectious mononucleosis (glandular)

Answer 98

``` FEVER Exudative pharyngitis Tonsillitis Lymphadenopathy Splenomegaly Palatal petechiae Rash ```

Question 99

Management of mono

Answer 99

None | Steroids only if airway obstructed due to tonsillar enlargement

Question 100

What is TTN? RF?

Answer 100

Tachypnoea of the newborn (TTN) = wet lung retention of fetal long fluid □ C-section without labour -> 'Cold' c-section = no maternal hormone surge hasn't caused resorption of fluid yet □ Breech delivery □ Male sex □ Birth asphyxiation □ Heavy maternal analgesia

Question 101

characteristic CXR for TTN

Answer 101

Coarse streaking w fluid in fissures

Question 102

Mx TTN

Answer 102

most babies settle in 24-48 hours with minimal handling and cot O2. CPAP if acidotic, low sats, working hard to breathe.

Question 103

Signs of resp distress in a newborn

Answer 103

○ Tachypnoea (>60breaths/min) § In response to incr CO2 in order to breathe out and decr the CO2 ○ Expiratory grunt § Produced by exhalation against a partially closed glottis in order to increase PEEP and therefore keep alveoli open § May be interpreted as crying or moaning ○ Recession of intercostal spaces and suprasternum; in drawing of subcostal margin § Due to the increased resp effort generating more negative intrapleural pressure which sucks in the softer/more compliant chest wall during inspiration ○ Nasal flare § Flare during inspiration decreases airway resistance ○ Central cyanosis § Note - polycythaemic babies will appear cyanosed at relatively high O2 sats but babies with low Hb will not appear cyanosed until saO2 is v low. ○ Deranged temperature control ○ Low O2 saturation

Question 104

Ix for resp distress in a neonate

Answer 104

``` BSL CXR FBE, blood film, UEC Blood culture VBG ```

Question 105

What is infant RDS? Another name for it? Who gets it (RF)? Treatment?

Answer 105

= hyaline membrane disease § Occurs in pre-term infants due to surfactant deficiency in the alveoli Mx: Empirical abx because looks similar to sepsis! CPAP If need more, intubate and give surfactant (need intubation).

Question 106

Characteristic CXR appearance of RDS/HMD

Answer 106

Hypo aeration, diffuse ground-glass appearance, air bronchograms

Question 107

RF for meconium aspiration?

Answer 107

Post-term (>40 weeks) | Births involving fetal distress

Question 108

what is the pathophys behind meconium aspiration syndrome?

Answer 108

Aspiration of substances leads to obstruction, atelectasis and chemical and mechanical pneumonitis

Question 109

RF for neonate sepsis

Answer 109

Maternal GBS positive Maternal fever Prolonged rupture of membrane (>=18 hours)

Question 110

Signs of pneumothorax

Answer 110

``` Most sensitive is transilluminator Tracheal deviation Chest asymmetry Unequal expansion Decr breath sounds unilaterally Resp distress ```

Question 111

Abx coverage for neonatal sepsis (what bugs are you worried about?)

Answer 111

Gentamicin (listeria, e coli, HIB) | Benzyl-penicillin (GBS)

Question 112

Differentials for resp distress

Answer 112

``` TTN/wet lung HMD/RDS Meconium aspiration syndrome Sepsis pneumothorax congenital pneumonia Cardiac (VSD, PDA, transposition, pulm HTN) Anatomical - although not usually in neonatal period (laryngomalacia etc) Drugs ? ```

Question 113

RF for pneumothorax in neonates

Answer 113

Being on CPAP | Resp distress

Question 114

Mx for MDS

Answer 114

NO evidence for suctioning airways (UNLESS baby is floppy or has no/inadequate respirations then it is reasonable to suction under direct vision using laryngoscope) Septic workup CPAP if needed/intubation

Question 115

metabolic disturbances causing apnoeic episodes in premmies

Answer 115

Hypoglycaemia, hypocalcaemia, hypo/hypermagnesaemia

Question 116

Define apnoea in neonates

Answer 116

§ No air flow occurs for >=20sec § No air flow for >=10sec + bradycardia or desat

Question 117

General management of Respiratory distress in neonates

Answer 117

Observation - admit to neonatal nursery, incubator Monitor vital (HR, RR, saO2) Septic workup (FBE, blood film, blood cultures, CXR, vBG) Empiric antibiotics (gent and benpen) IV fluids (10% dextrose at 60ml/kg daily) Advice from senior physician! Additional resp support (CPAP, intubation)

Question 118

Definitions for - term - pre term - post term

Answer 118

* term: ≥ 37 completed weeks' gestation * preterm: < 37 completed weeks' gestation * post-term: > 42 completed weeks' gestation

Question 119

Definitions for - LBW - VLBW - appropriate weight for gestational age

Answer 119

• low birth weight (LBW): < 2500 g • very low birth weight (VLBW): < 1500 g - appropriate weight for gestational age; between 10th and 90th percentiles

Question 120

3 things to look for on GI when examining a baby

Answer 120

1. pink (well perfused) 2. no incr WOB (resp effort) 3. active, good tone

Question 121

when is bronchiolitis most common?

Answer 121

Up to 2 years of age | In winter/rainy season

Question 122

Risk factors for bronchiolitis

Answer 122

Maternal smoking, pre-term delivery, chronic lung disease of prematurity, allergy, CHD, immunodeficiency

Question 123

common causative agents of bronchiolitis

Answer 123

``` VIRAL always Rhinovirus #1 cause of mild bronchiolitis RSV #1 cause of SeVere bronchiolitis HRV Parainfluenza, influenza A/B Adenovirus ```

Question 124

SX and signs of Bronchiolitis

Answer 124

``` Low grade fever § Tachypnoea § Mild dry cough § Expiratory wheezing § Hyperinflation § WOB § Fine inspiratory crackles § Difficulty feeding if severe ```

Question 125

Mx of bronchiolitis

Answer 125

○ Mx - supportive (O2, fluids, nutrition)

Question 126

What is the most common cause of wheeze in the first 2 years of life?

Answer 126

Viral bronchiolitis

Question 127

Complications of Pertussis (whooping cough) who is most at risk?

Answer 127

Apnoea, severe pneumonia, encephalopathy, death Most at risk is <6mo

Question 128

Clinical signs and investigations : Pertussis

Answer 128

§ Prodrome of a few days: nasal discharge and mild dry cough § Cough becomes more pronounced and characteristically 'whoop'ing § +/- severe vomiting and subconjunctival haemorrhages § Apnoea in young infants Ix: nasopharyngeal specimen: immunofluorescent Ab, culture

Question 129

Treatment of pertussis

Answer 129

§ Admission for supportive therapy § Macrolide antibiotics if early in course of disease or v severe Sx § Treat household contacts § Contact precaution (until 5 days of antibiotics or illness for 3 weeks)

Question 130

Most common causes of viral pneumonia in kids

Answer 130

``` parainfluenza influenza RSV Human metapneumovirus (HMV) Adenovirus Human rhinovirus ```

Question 131

What does an x ray of viral pneumonia look like?

Answer 131

CXR: patchy, widespread bilateral infiltrates rather than lobar involvement

Question 132

Clinical présentation of viral pneumonia

Answer 132

Dry cough Fever LOA

Question 133

Complications of HIB

Answer 133

Epiglottitis | Meningitis

Question 134

Risk factors for HIB

Answer 134

``` Age <5yo Indigenous Lower SES Male sex Congenital and acquired immunodeficiency ```

Question 135

Causative agents of bacterial pneumonia

Answer 135

1. Strep pneumonia most common by far! 2. Staph aureus 3. Mycoplasma pneumonia 4. HIB Less common causes: - Group A beta haemolytic strep (pyogenies) - Klebsiella

Question 136

Presentation of pneumococcal pneumonia Typical CXR findings

Answer 136

``` fever sob pleuritic CP wet cough tachypnoea grunting nasal flaring Reduced expansion, dull to percussion, reduced breath sounds, bronchial breathing on affected side ``` CXR: lobal opacification although can be patchy

Question 137

What antibiotics to use for pneumococcal pneumonia?

Answer 137

Penicillin and third gen cephalosporin

Question 138

lung complications of pneumonia what clinical features are the same, and what are different?

Answer 138

Pleural effusion Pneumothorax same - tracheal deviation and reduced breath sounds different - stony dull percussion and bronchial breathing above effusions.

Question 139

what is the typical CXR appearance of mycoplasma pneumonia?

Answer 139

Central peribronchial opacification Extensive opacification of 1+ lobes Air bronchograms

Question 140

Presentation of staph pneumonia

Answer 140

``` □ Shorter acute HX than other forms of pneumonia (acute onset, rapid course) □ Appears more toxic □ High fever □ Marked tachypnoea □ Significant resp distress □ Non-specific chest signs ```

Question 141

Complications of staph pneumonia

Answer 141

``` LARGE pleural effusions Empyema Tracheal deviation Abscesses Air leaks (pneumothorax) ```

Question 142

Antibiotics for staph pneumoniae

Answer 142

IV flucloxacillin and third generation cephalosporin (cefotaxime) Vancomycin if MRSA suspected

Question 143

RF for staph pneumonaie

Answer 143

Low SES | Indigenous b/g

Question 144

Examples of ACYANOTIC heart defects

Answer 144

``` 1. L->R shunt VSD PDA ASD AVSD ``` ``` 2. Obstructive heart defects Pulmonary stenosis Aortic stenosis Coarctation of aorta Hypoplastic L heart syndrome ```

Question 145

Presentation of a VSD

Answer 145

Depends on the size 1. Small: pan systolic murmur @ L sternal edge rad to axilla BUT ASYMPTOMATIC at birth bc pressures between L and R heart are equal 2. Large: left heart dilatation leads to displaced apex, parasternal heave - SX of HF occur after lungs open up and L sided pressures > R. (poor feeding, FTT, tachypnoea, incr WOB, hepatomegaly) Note: L heart dilatation occurs because L heart has to work harder to generate the same CO w shunt present.

Question 146

what are the 2 most common types of CHD in kids?

Answer 146

1. VSD | 2. PDA

Question 147

What are SX of heart failure in a newborn?

Answer 147

tachypnoea SOB and sweating when feeding Failure to thrive Incr WOB

Question 148

Long-term complications of VSD

Answer 148

® Progressive AR if shunt is located close to aortic valve (aortic leaflets sucked/prolapses into defet due to high-velocity L->R flow) Pulmonary HTN due to Increased pulmonary pressures (L-> R shunt)

Question 149

What causes the ductus arterioles to close? when does this occur?

Answer 149

Closes in first 1-7 days post birth due to decreased circulating PGE2 and increased paO2, as well as muscle contraction

Question 150

What can cause the ductus arteriosus to fail to close?

Answer 150

Prematurity | Congenital malformation

Question 151

What is the treatment for a PDA in a premature infant?

Answer 151

Indomethacin or other NSAIDs (inhibit PGE2 to promote ductal constriction and closure)

Question 152

Why do you treat small PDAs and how? How does this differ from treatment of large PDAs?

Answer 152

Small PDAs are treated to prevent endocarditis rather than to treat symptoms or complications. Via transcatheter duct occlusion. Large PDAs need surgical ligation .

Question 153

How do PDAs present?

Answer 153

Small PDAs generally asymptomatic. May have continuous murmur at upper L sternal edge. Large PDAs present with L heart dilatation (displaced apex beat, parasternal heave) and progressive SX of heart failure. + Bounding pulses + Apical mid-diastolic murmur

Question 154

What investigations do you do if you hear a murmur in a baby?

Answer 154

CXR ECG ECHO is diagnostic

Question 155

Where do most ASDs occur?

Answer 155

fossa ovale (central part of atrial septum)

Question 156

How do ASDs present?

Answer 156

Small ASDs go undetected (low pressure gradient across atria) Large ASDs rarely symptomatic in childhood -may cause Atrial arrhythmias in adulthood, and reduced exercise capacity Because L->R shunt causes R heart enlargement -> - parasternal heave - ES murmur in pulmonary region with fixed splitting of A2 and P2

Question 157

What might an ECG of ASD show?

Answer 157

partial RBBB

Question 158

What is the treatment for ASD and when is it indicated?

Answer 158

Indicated if patient has RH enlargement Transcatheter or surgical closure

Question 159

Which congenital heart defect is most assoc w down syndrome?

Answer 159

AVSD

Question 160

How does AVSD present?

Answer 160

Partial AVSD - behaves physiologically and symptomatically like ASD Complete AVSD - presents like severe VSD (FTT, feeding difficulties, tachypnoea, WOB)

Question 161

Treatment of AVSD

Answer 161

almost always needs surgical closure

Question 162

What is the most common type of Acyanotic obstructive heart defect? What type of murmur is associated?

Answer 162

Pulmonary Stenosis Ejection systolic @ L upper sternal edge Radiating to back Ejection click earlier than with AS A2 and P2 widely split

Question 163

how does pulmonary stenosis present?

Answer 163

usually asymptomatic in children and infants Mild is benign, non-progressive finding Severe can lead to heart-failure

Question 164

What causes AS in children usually. What type of murmur?

Answer 164

Bicuspid aortic valve ES murmur over aortic area + radiation to carotids Ejection click later than PS Less splitting of A2 and P2 than PS

Question 165

How might AS present in kids

Answer 165

ES murmur Apical heave due to LV hypertrophy Gradual progression of SX (syncope, angina, dizziness on exertion, sudden death) Severe cases, HF evident at birth

Question 166

When do you treat AS in kids? How?

Answer 166

If symptomatic or ECG changes w exercise ``` Balloon valvuloplasty (trans-acth) or aortic valvotomy (surgical) ```

Question 167

what is coarctation of the aorta? What can it result in?

Answer 167

Stricture at distal part of aortic arch (max obstruction site close to aortic end of Ductus arteriosus) Can lead to severe cardiac failure in newborns with oliguria and acidosis

Question 168

When does cardiac failure onset in newborns with coarctation of aorta? How might this present on exam?

Answer 168

When ductus arteriosus closes because then there is NO blood flow to the rest of the body. Diminished/absent femoral pulses unequal BPs between L and R arm

Question 169

Treatment of coarctation of aorta

Answer 169

surgical repair as early as possible!!

Question 170

CXR findings of severe coarctation of aorta

Answer 170

Cardiomegaly Pulmonary congestion Abnormal appearance of aortic knuckle Rib notching (due to enlarged IC arteries bypassing obstructed segment of aorta)

Question 171

If a newborn has coarctation, what else might you expect?

Answer 171

other congenital heart defects such as : VSD PDA valvular abnormalities

Question 172

How does hypo plastic L heart syndrome present? What is it?

Answer 172

§ Infants present w severe cardiac failure or shock within first few days of life □ All periph pulses diminished or absent Small left ventricle (hypoplasia) - Underdevelopment of left heart + valves (often assoc w severe MS and AS)

Question 173

What is hypo plastic left heart syndrome always associated with

Answer 173

always assoc w PDA otherwise they would have died. Necessary to keep systemic circulation maintained (R->L shunt due to R ventricular blood shunting via PDA into aorta )

Question 174

Complications of Hypoplastic left heart syndrome

Answer 174

95% die within first few weeks of life if untreated Neurodevelopment impairment if children survive due to marked hypoxia and cyanosis in early days of life

Question 175

Treatment for Hypoplastic left heart syndrome

Answer 175

Immediate: PGE1 keeps PDA patient initially, until SURGERY can be performed. If untreated 95% die in first few weeks of life.

Question 176

Examples of cyanotic heart defects

Answer 176

The 4 Ts: 1. Tetralogy of ballot 2. Transposition of great arteries 3. Tricuspid atresia 4. Truncus arteriosus

Question 177

what is the most common cyanotic heart defect? What is it commonly assoc with?

Answer 177

tetralogy of fallot? | Syndromes -down syndrome

Question 178

What is the tetralogy of fallot and what 4 things comprise it?

Answer 178

Obstruction to RV outlfow tract + septal defect below obstruction such that blood can flow from RV to LV (R->L shunting) ``` § 4 anatomical defects: □ Overriding aorta □ RV hypertrophy □ Pulmonary stenosis □ VSD ```

Question 179

Clinical picture of tetralogy of fallot

Answer 179

Kids: Gradual, delayed development of cyanosis Delayed exercise tolerance, finger clubbing, growth retardation Development of compensatory polycythaemia Babies: 'tet' spells: cyanosis more obvious when baby is upset, crying (Baby may go floppy, lose consciousness)

Question 180

What do you suspect if a baby becomes cyanosed only when upset and crying, and on one occasion goes floppy and loses consciousness during such an episode? What do you do to manage this?

Answer 180

Tetralogy of fallot Treatment - soothe the baby

Question 181

Treatment for tetralogy of fallot in kids?

Answer 181

get older kids to squat to incr systemic vasc resistance and reduce R->L shunting Surgical closure of VSD and repair of PS

Question 182

what type of murmur do you hear, if any, in tetralogy of fallot and what is this due to?

Answer 182

Ejection systolic murmur over pulmonary region due to PS (not VSD)

Question 183

What changes would you see on CXR with tetralogy of fallot?

Answer 183

Normal heart size; 'boot shape' (upturned apex), reduced lung vascularity (fields look blacker)

Question 184

What is transposition of great arterities?

Answer 184

§ Aorta and pulmonary arterty connected to wrong side of heart and as a result venous blood is directed straight through into systemic circulation § 2 parallel circulations result with ® Systemic venous deoxy blood flowing through R heart back into aorta ® Pulmonary venous oxy blood flowing through L heart back into pulm circulation

Question 185

What does survival depend on with transposition of great arteriess?

Answer 185

§ Survival depends on mixing of blood between circuits via foramen ovale, ductus arterosus or septal defect

Question 186

Clinical presentation of transposition of great arteriess?

Answer 186

® Cyanosis present at birth and generally progresses gradually ® +/- metabolic acidosis from tissue hypoxia ® No murmur

Question 187

CXR findings for transposition of great arteriess?

Answer 187

mildly hypertrophied heart w contour 'egg on its side', increased pulmonary vascular markings

Question 188

Treatment for transposition of great arteriess?

Answer 188

® Balloon atrial septostomy (intra-cath) to forcefully create an ASD as an emergency procedure to improve systemic arterial O2 sat ® Surgical correction = arterial switch (transection and re-anastamosis of great arteries to appropriate ventricle) ® Perform within first few weeks of life so you don't get atrophy of LV

Question 189

Complications of kawasaki disease

Answer 189

risk of coronary artery aneurysms, myocardial ischemia or infarction

Question 190

What is myocarditis caused by and what are potential complication(s)? Treatment?

Answer 190

Triggered by common viral infection, is immune-mediated Compl: CCF, arrhythmias Treatment: supportive +/- IV IG or immunosuppressives

Question 191

What is the risk with long QT syndrome?

Answer 191

At risk of ventricular tachyarrhythmias (VT or VF) with sudden urges in adrenergic drive (exercise, morning alarm), which can lead to sudden death. Runs in family. ask about fam HX of sudden death Treatment: anti arrhythmic drugs, auto defib. implant

Question 192

Treatment for heart block

Answer 192

® Positive chronotropic agent (isoprenaline) ® OR Positive Inotropes ® Implantation of temporary or permanent pacemaker

Question 193

What are shockable rhythms?

Answer 193

VT and VF?

Question 194

How might SVT present? What do you see on ECG?

Answer 194

Babies - mild distress w tachypnoea and poor feeding. Kids - complain of palpitations ECG shows Wolf-Parkinson White syndrome (rapid regular tachycardia 200-300bpm with narrow QRS)

Question 195

Treatment for SVT

Answer 195

Vagal manoeuvres (valsalva) or IV adenosine to terminate an acute episode DC cardioversion if haemodynamically compromised

Question 196

When might you pick up heart block in a baby?

Answer 196

Uncommon but may pick it up on routine antenatal assessment (monitoring /ECG) w fetal bradycardia <60bpm

Question 197

pathophys of RHD What can it lead to?

Answer 197

Autoimmune: host immune response to strep Ag -> attacks heart, synovial membranes, other tissues (mainly damages heart VALVES) Can cause myocarditis, pericarditis leading to reduced ventricular function (CCF) and arrhythmias, and mitral and aortic stenosis/incompetence

Question 198

How does RHD present?

Answer 198

Follows acute rheumatic fever (strep infection of throat or tonsils) - Polyarthtiris, large joints - Carditis - NEW ONSET MURMUR - Sydenham chorea - Transient truncal skin rash (erythema marginatum) - Skin nodules over bony prominences - Fever

Question 199

Causes of nephrotic syndrome

Answer 199

Idiopathic (90%) - minimal change disease (85%) - FSGS (15%) Non-idiopathic (10%) - HSP - SLE - Membranoproliferazive GN - Membranous nephritis - Congenital nephrotic syndrome

Question 200

What are the key features of nephrotic syndrome?

Answer 200

Heavy proteinaemia Oedema Hypoalbuminaemia Hyperlipidaemia Note: may get some haematuria and FSGS can cause HTN. Don't generally get renal impairment

Question 201

Key features of nephritic syndrome

Answer 201

Haematuria Acute fluid overload Hypertension Renal impairment

Question 202

Complications of nephrotic syndrome

Answer 202

Hypovolaemia Infections Thrombosis (haemoconcentration and loss of antithrombin in urine)

Question 203

Signs of renal impairment

Answer 203

Oliguria Increased plasma creatinine Deranged UECs

Question 204

Potential results of acute fluid overload

Answer 204

oedema pulmonary oedema CCF

Question 205

When do you investigate isolated haematuria?

Answer 205

isolated haematuria is common and usually benign when there is no history of kidney disease. Further investigations only if it occurs in 3 diff specimens over period of 2-3 weeks

Question 206

Causes of nephritic syndrome

Answer 206

Idiopathic hypercalciuria ( excessive urinary calcium excretion) Thin basement membrane disease (benign familial haematuria) Proliferative glomerulonephritis (IgA nephropathy, post-strep GN, SLE, HSP)

Question 207

What is post-strep glomerulonephritis caused by and what is the typical presentation?

Answer 207

Group A beta haemolytic strep (progenies) ○ Follows 7-14 days after group A beta haemolytic strep throat infection or 3-6 weeks following strep skin infection ``` Presents w: MACROSCOPIC haematuria acute fluid overload (facial and leg oedema +/- papilloedema) HTN Lassitude, fever, loin pain ```

Question 208

Mx of post-strep GN

Answer 208

Oral penicillin for 10 days If fluid overloaded: fluid restrict, low salt diet, frusemide Dialysis if urea >50-60mmol/L, or hyperkalaemia or pulmonary oedema not controlled by diuretics and fluid restriction

Question 209

electrolyte changes in renal failure

Answer 209

Incr: K, phosphate, Mg, urea, creatinine, H Decr: Na, Ca Metabolic acidosis

Question 210

What is the clinical picture of IgA nephropathy

Answer 210

``` Macroscopic haematuria (haematuria often occurs at same time as intercurrent viral infections) ``` May present as acute renal failure with gross oedema and HTN May be asymptomatic

Question 211

Changes expected on positive SLE bloods

Answer 211

§ Serum C3 low | § ANA, anti-dsDNA positive

Question 212

Protein in urine can be normal in many kids. At what time doing a alb: creatinine spot test would you expect to see abnormally elevated results.

Answer 212

First morning void (Should be negligible if normal). In normal kids with no pathology, incr protein secretion occurs during the day, NOT overnight

Question 213

How does minimal change disease typically present

Answer 213

``` Children <10 Generalised oedema (facial puffiness, peripheral oedema, ascites) ``` NORMAL BP and renal function 30% have microscopic haematuria Normal C' levels

Question 214

Treatment for nephrotic syndrome

Answer 214

Steroids | Fluid restriction and low salt diet if fluid overloaded +/- albumin

Question 215

Complication of ascites

Answer 215

Spontaneous bacterial peritonitis (infection with encapsulated bacteria such as klebsiella, pseudomonas, e coli, staph aureus, strep pneumonia)

Question 216

When would you suspect FSGS in a kid with nephrotic syndrome What is the prognosis?

Answer 216

If they are steroid and/or immunosuppressant resistant If they have multiple relapses Prognosis is poor - 60% progress to ESKD over 10 years.

Question 217

Investigations for atopy

Answer 217

Skin prick testing is first line (needs specialist referral) Serological testing (lower specificity and sensitivity)

Question 218

What is cystic fibrosis?

Answer 218

Autosomal recessive disorder common in caucasian population caused by defect in CF transmembrane conductance regulator gene which codes for a Cl channel present on epithelial cells of the conductive airways and GIT

Question 219

How might cystic fibrosis be diagnosed?

Answer 219

Neonatal screening Meconium ileus Positive sweat test ([Cl]>40) In adulthood, presentation with pseudomonas pneumonia or male infertility (due to bilateral absence of vas deferens)

Question 220

What is the pathophys behind cystic fibrosis

Answer 220

Defective or absent Cl channel means that Cl is not getting pumped into secretions which would normally draw water in to thin secretions out, so as a result secretions are abnormally viscous. Thick meconium can get stuck and lead to meconium ileum (emergency! Ciliary dysfunction and damage due to thick mucus build up Leads to mucus buildup and inflammation and recurrent infection in lungs initially. Recurrent infections and mucus buildup lead to bronchiectasis Leads to thickened pancreatic secretions that block exocrine secretion from pancreas. protein and fat aren't absorbed -> poor weight gain, FTT, Steatthorea. Over time pancreas is damaged from backed up enzymes and can lead to acute or chronic pancreatitis. Eventually leads to pancreatic endocrine dysfunction leading to insulin-dependent diabetes

Question 221

Bugs that kids with cystic fibrosis are particularly prone to

Answer 221

Staph aureus (GP) and pseudomonas (GN)

Question 222

Chronic complications of Cystic fibrosis

Answer 222

Bronchiectasis from recurrent/chronic lung infections. Respiratory failure and death Nasal polyps Digital clubbing Infertility in men due to bilateral absence of vas deference Pancreatic failure Liver disease Growth delay Osteoporosis Urinary incontinence

Question 223

4 domains of development

Answer 223

○ Gross motor ○ vision and Fine motor ○ Social, emotional, daily living ○ Communication, language, hearing

Question 224

What are the 3 common features of all kids with cerebral palsy

Answer 224

□ Deformity, contracture, hip dislocation □ Tone and/or movement disorder □ Spasticity, dystonia, chorea etc NOT all kids w CP have intellectual disability!

Question 225

What should all kids w possible developmental delay/behavioural and attention difficulties get done (Inx-wise)?

Answer 225

Formal hearing and vision testing | speech assessment

Question 226

What does HEADSS stand for?

Answer 226

``` Home Education Activities (hobbies etc) Alcohol • A lot of kids your age start experimenting w drugs and alcohol - have you ever tried any alcohol, or drugs? ``` Drugs Sex/sexuality • Are you involved in a romantic relationship?? Suicide

Question 227

when do solids get introduced?

Answer 227

between 4 and 6 months

Question 228

when should babies be sleeping through the night by?

Answer 228

3-6 months .

Question 229

When to refer to speech and audiology assessment for a child with 'language' delay?

Answer 229

<50 words at 2yo or no 2 word combinations at 2yo | Doesn't understand simple instructions without gesture

Question 230

When to refer to speech and audiology assessment for a child with 'language' delay?

Answer 230

<50 words at 2yo or no 2 word combinations at 2yo | Doesn't understand simple instructions without gesture

Question 231

What are the 3 realms of problems that kids w Autism have?

Answer 231

1. problems w socialisation 2. problems w communication 3. repetitive or obsessive behaviours

Question 232

What is the mean IQ ?

Answer 232

IQ: mean 100 w SD of 15

Question 233

Differentials for developmental delay

Answer 233

○ Deprivation/abuse ○ Neurodegenerative disorder ○ Unrecognised epilepsy ○ Severe sensory or developmental disorders (ASD, ADHD, cerebral palsy) ○ Cultural differences, mental health disorders, ill health, refusal to participate ○ Movement difficulties

Question 234

what is the screening for down syndrome?

Answer 234

§ 1st and 2nd trimester serum markers □ Low alpha-fetoprotein and pregnancy associated plasma protein A □ High chorionic gonadotrophin levels □ Low blood oestriol levels § US findings - nuchal thickening, characteristic malformations

Question 235

characteristic dysmorphic features of down syndrome

Answer 235

§ Hypotonia § Eyes slated, epicanthic folds, brushfield spots § Tongue appears large § Ears small and poorly formed § Hands broad, simian crease (single palmar crease) Gap between first and second toes

Question 236

Diagnosis of down syndrome

Answer 236

Microarray or FISH (genetic testing showing trisomy 21)

Question 237

Common co-occurring malformations with Down syndrome

Answer 237

§ Congenital heart disease (tetralogy of fallot, AVSD etc) | § GI malformation (duodenal atresia, imperforate anus, Hirschsprung disease)

Question 238

Pathological Causes of constipation in kids

Answer 238

``` SC lesions Spina Bifida Intestinal neuropathy (Hirschsprung's) Cow milk protein intolerance Coeliac disease Cystic fibrosis Metabolic (hypothyroid, hypercalcaemia) Pyloric stenosis, malrotation +/- volvulus, incarcerated inguinal hernia Cerebral palsy Drugs ```

Question 239

Causes of delayed passage of meconium

Answer 239

``` Cystic fibrosis Malrotation +/- volvululus Fistula Imperforate anus Down Syndrome Hirschsprung's ```

Question 240

Functional causes of constipation in kids

Answer 240

Physiological/functional - withholding behaviour - pain - anxiety - diet - dehydration - change in lifestyle (weaning onto solids, toilet training, starting school)

Question 241

What is fecal incontinence associated with?

Answer 241

- Painful or frightening event assoc w defecation in early childhood - Limited attention or learning disability - Nocturnal enuresis/urinary incontinence - Constipation (overflow)

Question 242

Management of constipation in kids

Answer 242

1. Change behaviour (toilet sits, position on toilet, stool diary) 2. Diet - incr fluid and fibre, healthy diet 3. Education 4. Disimpaction if there is significant impaction that they are unlikely to pass 5. Laxatives Regular review and monitoring

Question 243

What are the mechanisms of action of the following laxatives: 1. Paraffin oil 2. Senna 3. Coloxyl 4. Movicol 5. Osmolax 6. Colonlytely

Answer 243

1. Paraffin oil - lubricant/softener 2. Senna - stimulant 3. Coloxyl - Softener 4. Movicol - osmotic 5. Osmolax - osmotic 6. Colonlytely - osmotic

Question 244

Exam and Ix for constipation

Answer 244

Exam - Neurological lower limb motor and sensory (neurological/spinal abnormalities) - Abdominal exam (faecal masses?) - Height, weight (FTT) - Spine and external exam of anal region (sacral teratoma, spina bifida, imperforate anus) Ix - none unless SX continue despite behavioural modifications and laxative therapy, then look into pathological causes

Question 245

what is the most common cause of constipation in kids?

Answer 245

Functional at >95% cases

Question 246

Causes of vomiting in neonates

Answer 246

Systemic infx/sepsis Bowel obstruction (anal atresia, duodenal atresia, Hirschsprung, meconium ileus w CF, incarcerated inguinal hernia) Hypoglycaemia Malrotation +/- volvulus UTI/renal disease Adrenal insufficiency (congenital adrenal hyperplasia, w ambiguous genitalia in females)

Question 247

Causes of vomiting in infants

Answer 247

``` infection lesions of GIT (malrotation, strangulated inguional hernia, pyloric stenosis) GORD Coeliac Gastroenteritis Intussception (3-12mo) ```

Question 248

Causes of vomiting in older kids

Answer 248

Migraine headache Sepsis Intracranial neoplasm (morning vomiting and headaches) Acute appendicitis and peritonitis (>5yo) Poisoning Psychological (anxiety, stress)

Question 249

SX and Treatment of overactive bladder

Answer 249

SX - frequency, incontinence, bed wetting, HOCKERING posturing +/- fecal incontinence often resistant to alarms and desmopressin, persisting beyond 10yo Treatment - regular toiling program + anticholinergic (oxybutynin)

Question 250

Investigations for urinary incontinence

Answer 250

U/S KUB (?Structural abnormality) Uroflow (filling or emptying problem?) Post-void U/S (?Residual volume)

Question 251

Treatment of monosymptomaatic NE

Answer 251

Alarms worn at night Wetting diary Desmopressin (synthetic ADH/vasopressin analogue) - used for those who ave not responded or are unsuitable for alarm. Child should NOT drink overnight (risk hyponatraemia)

Question 252

Treatment of polysymptomatic NE

Answer 252

Alarms Treat constipation/fecal incontinence and exclude UTI Anticholinergics (oxybutynin) Frequent, regular voiding

Question 253

Causes of daytime wetting without NE

Answer 253

``` Urge incontinence (overactive detrusor muscle) - urgency, freq, posturing, wetting ``` ``` Dysfunctional voiding (lack of coordination between detrusor and bladder neck activity w poor relaxation of external sphincter during voiding) ASsoc w high residual volumes, upper tract dilatation MX- teach pelvic floor/sphincter relaxation and optimal voiding techniques ``` ``` Neurological - neurogenic bladder (large of expressible bladders +/- NE ) Urological pathology (fistula, ectopic ureter) - constant rather than episodic bladders, may have NE too ```

Question 254

Risk factors for DDH

Answer 254

Female ○ Breech presentation ○ Positive family history of DDH Oligohydramnios

Question 255

Detection of DDH O/E and Inx

Answer 255

§ Ortolani - detects dislocated hip reducing during exam § Barlow - detects dislocating or subluxing during exam § Positive tests are ones in which 'clunk' is felt (click/popping) § Other signs to look for: □ Discrepancy in leg length □ Asymmetrical thigh skin folds (also present in 25% normal babies) ○ Ix: ultrasound <6months X-rays > 6 months

Question 256

Treatment for DDH | What happens if not treated early?

Answer 256

Tx: Pavlik harness. If not treated early, hip joint develops abnormally and open or closed surgical reduction is required

Question 257

What is DDH?

Answer 257

spectrum of disorders of hip instability producing subluxation or dislocation and imaging features of poor acetabular development

Question 258

Commonest organisms for meningitis

Answer 258

<2 years old § Group B strep (pyogenes) § E coli and other GNB § Listeria monocytogenes ``` >2 years old § above § Strep pneumoniae § Neisseria meningitis § HIB (in unimmunised children) ```

Question 259

Commonest organisms for encephalitis

Answer 259

Viruses - Enterovirus - HSV - Other herpes (EBV, CMV, HHV6, VZV) - Arbovirus Bacteria, fungal, parasite causes RARE

Question 260

Exam features of meningitis

Answer 260

Full fontanelle +/- neck stiffness Purpuric rash suggests meningococcal septicaemia

Question 261

Signs of encephalitis

Answer 261

Altered conscious state, focal neurological signs

Question 262

interpretation of CSF for viral vs bacterial meningitis

Answer 262

``` Bacterial Neutr=100-10000 (higher) Lymph<100 (lower) protein >1g/L (higher) glucose <0.4 ``` ``` Viral Neutr<100 (lower) Lymph 10-1000 (higher) Protein 0.4-1g/L (lower) Glucose normal ```

Question 263

MX of meningitis - encephalitis

Answer 263

Meningitis -Bacterial <2mo: IV Cefotaxime and benpen >2mo: IV ceftriaxone +/- dexamethasone (reduces risk of hearing loss) Enceph: viral -> acyclovir Analgesia Admission if bacterial meningitis or IV hydration required (bolus if shocked -> 2/3 maintenance) Monitor: - Neurological obs - BP readings - Weight and HC - UEC to monitor for electrolyte abnormalities whilst on IV fluids

Question 264

what does AVPU stand for?

Answer 264

``` A Alert V Responds to voice P Responds to pain - Purposefully - Non-purposefully - Withdrawal/flexor response - Extensor response U Unresponsive ```

Question 265

age range for epidiymitis

Answer 265

1) Only occurs immediately after birth (times when you have surges of androgens which open the vas) or in 14 + year olds

Question 266

what is the anatomical variant that predisposes boys to testicular torsion?

Answer 266

'Bell-clapper testes' - anatomical variant where the testes hangs on longer mesentary than usual so more prone to twisting (within tunica)

Question 267

How long do you have to save the testes from infarct with testicular torsion?

Answer 267

Have 6 hours with testicular torsion to save the testes from infarct

Question 268

What is another name for idiopathic scrotal oedema and what is it's typical presentation?

Answer 268

Allergic cellulitis Bilaterally red swollen skin w surrounding skin also red (inflammation not contained by tunica vaginalis) Often caused by flea bite on groin Often presents in middle of night, quick onset (<4-6h)

Question 269

MX of idiopathic scrotal oedema

Answer 269

Conservative - self limiting within 1-2 days

Question 270

DDX Left hemiscrotum is enlarged and blue - painless hard lump within scotum of a baby Ix?

Answer 270

Most commonly due to torsion of testes in utero DDX: testicular tumour Ix: Inguinal exploration to distinguish

Question 271

Enlarged non-erythematous right scrotal mass DDX How else might this present?

Answer 271

Cancer - probably rhabdomyosarcoma of cremaster muscle (cancer of spermatic cord) May also present as lower urinary tract SX -haematuria +/-urinary retention

Question 272

Primary vs secondary head injuries

Answer 272

Primary: - Contusion vs contre-coup - Axonal shearing - Injury to intracranial blood vessels (extradural/subdural/SA haematoma/intraventricular bleed etc) - Recognise patterns of injuries and blows to consciousness Secondary - Seizures - Hypoglycaemic state - Brain hypoxia, hypercarbia - Cerebral oedema -> Raised ICP

Question 273

Assessing a burns victim

Answer 273

ABCDE Airway - cervical spine needs demobilisation - ensure patent airway (+/- adjuncts +/- intubation) Breathing - O2 via mask, highest flow possible - RR and SaO2 - Expose chest for chest trauma/burns, observe chest movement (if burns are restricting chest expansion, consider escharotomy) Circulation + haemorrhage control - Pulses, CRT - IV fluid resusc - Elevate limbs if there are circumferential burns (may restrict perfusion) +/- escharotomy Disability - AVPU - Pupil size, symmetry, response Exposure - Minimise heat loss (warm room, blankets, cover wound, Baer hugger) - Expose fully, remove everything - Burn assessment (depth, % TBSA)

Question 274

Management of a burns victim

Answer 274

``` Dressing (clingfilm/paraffin/acticoat) Tetanus status Fluids (use TBSA% as guide) Analgesia Tubes (NGT +/- IDC if TBSA >10% +/- intubation) ```

Question 275

What is the most common cause of newborn jaundice? Why?

Answer 275

Physiological jaundice - As a foetus, unconjugated bilirubin is excreted by placenta. During transition to hepatic conjugation and excretion, all infants have raised bilirubin to some degree.

Question 276

When is newborn jaundice always pathological

Answer 276

If it occurs within first 24 hours after birth (suspect haemolysis or sepsis) Conjugated hyperbilirubinaemia

Question 277

Why does physiological newborn jaundice occur?

Answer 277

1. Incr RBC turnover (t1/2 less) - incr unconj bilirubin load 2. Defective hepatic uptake 3. Decr efficiency of conjugation (lower UDPG levels) 4. Breast milk jaundice (factors in milk cause incr enteric absorption of bilirubin)

Question 278

Mx of newborn jaundice

Answer 278

1. Observe/watch 2. Blue light phototherapy (converts bilirubin into water-soluble form that can be excreted in bile and urine) 3. Exchange transfusion (replace baby's blood w donor blood to decr bilirubin levels rapidly) SBR Levels at which these are performed are determined using standard hospital monogram Abi if sepsis suspected

Question 279

When do you use a lower SBR threshold for phototherapy and exchange transfusion?

Answer 279

Premature Asphyxiated infant Ill or haemolysing infant

Question 280

How long should physiological jaundice last?

Answer 280

~1 week, with peak SBR levels at 3 days in term babies. | Peak at 1 week in preterm babies

Question 281

Causes of pathological jaundice

Answer 281

1. Haemolytic 2. Incr Haem load (haemorrhage, polycythaemia, swallowed blood) 3. Impaired hepatic uptake and conjugation (Gilbert, hypothyroid, drugs etc) 4. Mixed (prematurity, sepsis, infants of diabetic mothers, asphyxia)

Question 282

Complication of jaundice

Answer 282

kernicterus (neuronal death caused by toxic unconjugated bilirubin crossing the BBB) -> manifests as bilirubin encephalopathy Can lead to death or survival with cerebral palsy (neurodevelopment impairment)

Question 283

Haemolytic causes of jaundice

Answer 283

Immune - ABO and Rh blood group incompatibility - Drug-induced Acquired - bacterial sepsis - congenital intrauterine info Hereditary - G6PD deficiency - Hereditary spherocytosis

Question 284

What is the genetic underpinnings (at risk group) for G6PD deficiency

Answer 284

X linked Mediterranean Asian ethnic groups

Question 285

DDX - asymmetrical scrotum When is this most obvious?

Answer 285

1. Varicocoeal if bag of worms appearance (Most obvious when patient is vertical rather than horizontal) 2. Undecended testes 3. Cancer 4. torsion of testes or appendix testis 5. Hydrocoeal (although may be bilaterally swollen, giving dumbbell appearance)

Question 286

What side are variocoeals more common and why is this?

Answer 286

Left side Because pampiniform plexus in scrotum becomes enlarged due to impaired drainage

Question 287

How do you diagnose a hydrocoeal? Tx?

Answer 287

Transilluminates No treatment required

Question 288

Sx of benzo poisoning

Answer 288

CNS depression (drowsy, coma) REsp depression Hypotension

Question 289

Mx benzo poisoning

Answer 289

Observation - vitals, sats, RR (intubation, IV fluids, inotropes if necessary) Call POISONS, get help from consultant, ICU Urine drug screen (benzos) Antidote - flumazenil - not generally used. only under discussion from specialist. +/- Social work/department of Human Services referral

Question 290

DDX depressed conscious state in a 2.5 year old

Answer 290

Ingestion/poisoning (drugs/alchohl/pesticides/poisons/medications such as benzos, opioids) Head trauma Sepsis/meningitis

Question 291

How do you evaluate paracetamol levels?

Answer 291

Serum paracetamol levels at 4 hours post ingestion (testing any earlier doesn't help)

Question 292

Pain management in kids (and what is the pain score) 1. mild 2. moderate 3. severe

Answer 292

1. mild (pain score 1-3) - Oral panadol (20mg/kg loading dose then oraly 15mg/kg q4h as req) - Oral panadeine (15mg/kg/dose q4h paracetamol and codeine) - Oral ibuprofin (helps bring down swelling, use if they are eating and drinking) - distraction/bheavioural techniques 2. Moderate (pain score 4-7) - Intranasal fentanyl and midaz (helps w anxiety) - Codeine once pain has settled to mild/moderate 3. Severe (pain score 8-10) - SC Morphine 0.15mg/kg/dose q4h - IV morphine, titrated 4 hourly

Question 293

What does bilirubin bind in the blood?

Answer 293

Albumin

Question 294

Things to ask on HX when assessing a jaundiced baby

Answer 294

Family history: - spherocytosis - G6PD/ethnicity - Previously jaundiced children - splenectomy - haemolytic anaemia Antenatal HX: - blood group - maternal diabetes Birth HX Trauma - bruises/cephalhaematoma/ventouse extraction

Question 295

What is the blood volume of a newborn baby?

Answer 295

10ml/kg | so around a can of coke's worth in a term 3.5kg baby!

Question 296

What is breast milk jaundice?

Answer 296

Hormones in breast milk (+ added affect of constipation) result in increased enterohepatic circulation so more bilirubin is absorbed back into blood rather than being excreted. Normal and physiological

Question 297

What is the most common haemolytic cause of newborn jaundice? What is the most severe cause?

Answer 297

ABO incompatibility Mother is usually type O with baby type A Rh disease is more severe

Question 298

How do you test for blood group incompatibility in jaundiced babies?

Answer 298

Direct coombs test - strongly pos in Rh disease - negative or weakly pos in ABO incompatibility

Question 299

What is

Answer 299

Gal-1-P UT deficiency leads to build up of Galactose which is toxic

Question 300

Newborn baby is jaundiced and has pale poos. what do you suspect and how do you investigate this? why is it important to treat early?

Answer 300

Biliary atresia US of liver/biliary tree to investigate for obstructive causes Investigate within 6 weeks otherwise results in irreversible liver damage

Question 301

Risks associated with ABO incompatibility

Answer 301

Fetal hydrops Jaundice -> kernicterus/bilirubin encephalopathy

Question 302

Causes of short stature (3) and how is bone age related to chronological age in each? is the growth velocity normal or abnormal in each?

Answer 302

1. Familial Short Stature (bone age = chronological age) Normal growth vel. 2. Congenital Delayed Growth (bone age < chronological age) Normal growth vel. 3. Pathological (endocrine PICNICS) Abnormal growth vel.

Question 303

Pathological causes of delayed growth

Answer 303

Endocrine PICNICS Endocrine - hypothyroid, GH deficiency, Cushing's disease, adrenal insufficiency Psychosocial Iatrogenic - exogenous steroids, spinal Chronic disease - GI (coeliac, IBD); renal (CKD, RTA), cardiac (CHD), JIA, tumour Nutritional disease Intrauterine growth restriction Chromosomal - Turner syndrome, Down syndrome, Prader Willi Skeletal abnormalities

Question 304

Types of allergies

Answer 304

IgE mediated Non-IgE mediated

Question 305

HX for allergies

Answer 305

Quality - specific symptoms experienced Severity of SX - medical req to control SX - medical visits and hospitalisation - ICU admissions - interference w sleep, sport, play Timing: seasonal, perennial, episodic; immediate onset or delayed? Context: triggers Any HX of anaphylaxis

Question 306

SX of anaphylaxis (Severe allergic reactions) Children vs young kids

Answer 306

MUST have resp involvement or involvement of 2+ body systems - difficult/noisy breathing - Drooling - SOB, resp distress, cough, wheeze, hoarse voice, clearing throat, swelling/feeling of tightness in throat - Dizziness or collapse +/- drooling, Angio-edema/swelling of lips, tongue, hives/urticaria - Young kids: pale and floppy

Question 307

SX of mild to moderate allergic rxn

Answer 307

Swelling of lips, face, eyes Hives/welts Tingling mouth Abdo pain, vomiting

Question 308

Action plan for mild to moderate allergic Rxn

Answer 308

Mild to moderate: - Stay with person and call for help - Locate epicene adrenaline autoinjector - Give other medications if prescribed (+/- H2 antag for SX relief of pruritus +/- oral steroid tablets for bronchospasm) - phone family/emergency contact - watch for any ONE of the signs of anaphylaxis indicating resp involvement

Question 309

Action plan for severe allergic Rxn

Answer 309

Severe - Lay person flat - Give epicene adrenaline auto injector (pull of blue safety cap, place orange end against mid-thigh and push down hard until you hear a click -> hold for ten sec, then remove epipen and massage the spot). Can be given through clothing. - Phone ambulance 000 phone family/emergency contact - Further adrenaline doses can be given if no response after 5 min if you have another auto injector available WHEN IN DOUBT GIVE ADRENALINE (and always give adrenaline before inhaler if in doubt as to whether it is anaphylaxis or asthma)

Question 310

What are the investigations for allergy?

Answer 310

Ig E mediated: Skin prick testing: positive if welt >3mm Serology: measure allergen-specific Ig-E levels (more expensive and lower sensitivity and specitifiy but widely available) Both in conjunction with clinical history Immunotherapy --------------------- Non-IgE mediated and/or IgE mediated: Food challenge is gold standard but only perform at RCH (controlled environment)

Question 311

When is immunotherapy indicated as treatment for allergies?

Answer 311

For IgE-mediated inhalant or venom allergic disease only | Rhinoconjunctivitis as main indication

Question 312

Atopic diseases

Answer 312

Eczema (Allergic dermatitis) Asthma Allergic rhinoconjunctivitis (hayfever) Anaphylaxis

Question 313

What might you see on exam of someone with allergic rhino conjunctivitis?

Answer 313

- Mouth breathing - Inferior nasal turbinates pale and swollen - Clear nasal discharge - Conjunctivitis -itchy, red eyes w incr lacrimation

Question 314

Causes of failure to thrive (5)

Answer 314

1. *MAY BE PSYCHOSOCIAL* so take thorough social hX - blunts GH response 2. Inadequate intake - Neglect - Low SES - Poor diet - micronutrient deficiencies - inability to suck/swallow 3. Inadequate digestion, absorption - coeliac - CMPA - CF - pancreatic, cholestatic issue - Giardiasis - Diabetes 4. Incr metabolism - Carcinoma - Hyperthyroid - Chronic disease (resp, cardiac, renal, GI) 5. Prenatal issues - prematurity - maternal illness/drugs/smoking - IUGR - chromosomal abnormalities

Question 315

Investigations for short stature/FTT

Answer 315

Bone scan Bloods: FBE, UEC, LFTs - TFT, coeliac serology - Nutrition: CMP, Fe, vit D, B12, folate, IGF

Question 316

MX for short stature

Answer 316

1. education/reassurance 2. change diet 3. treat any underlying pathology 4. +/- GH therapy 5. psychosocial support

Question 317

How might pain present in a neonate? vs young child

Answer 317

``` Tachycardia Tachypnoea Restless/writhing/squirming Irritable Poor feeding ``` Young child: miserable, crying/screaming, lack of function, can verbalise pain

Question 318

What is a smegma?

Answer 318

Combination of desquamated skin cells, skin oils and moisture collects around the clitorus or under the foreskin of males. Looks like localised collection of pus but there are no signs of inflammation and it is normal in toddlers due to the foreskin separating gradually from penis between ages of 2 and 5!

Question 319

Ballinitis presentation Aetiology?

Answer 319

- Red, swollen, painful penis, often presenting in middle of night. - Common in 1-3 year old during period of separation of foreskin - Infection by e. coli or candida in pockets between inner layer of foreskin and penis (where smegma form)

Question 320

Treatment and prevention Ballinitis

Answer 320

Treatment: high dose topical antibiotics (eye ointment) squirted under foreskin every 2 hours until it's fixed (clears in 4-6 hours) Prevention: wash regularly in salt water (cooking salt in bath)

Question 321

What is parafimosis? Treatment

Answer 321

Foreskin trapped behind corona forming tight band of constricting tissue which causes venous obstruction and swelling of glans Treatment: urological emergency! Manipulation of glans within foreskin under laughing gas

Question 322

What is phimosis? When is treatment warranted and what is treatment? What are complications if not treated?

Answer 322

Inability to retract the skin covering the head (glans) of the penis May appear as a tight ring or 'rubber hand' of foreskin around tip of penis, preventing full retraction. Can be physiological (self-resolves around 5-7 years of age) or pathological (due to scarring, infection, inflammation). If there is ballooning of foreskin during urination/difficulty urinating, or infection, treatment (topical steroids +/- circumcision) may be warranted. Complications: renal failure due to complete obstruction of urinary tract

Question 323

What is hypospadias? | What is treatment?

Answer 323

Developmental condition where the meatus isn't at the tip of the penis. Instead, the hole may be any place along the underside of the penis. The meatus (hole) is most often found near the end of the penis ("distal" position) (80%), often occurring with dorsal hood of foreskin and chordee Tx: urological surgery within 6 weeks

Question 324

What is chord What is associated with? Tx?

Answer 324

Penis curves up or down at junction of head and shaft of penis, most obvious during erection Can be assoc w hypospadias Tx: surgery in infancy

Question 325

What is epispadius? What is it associated with?

Answer 325

URethra opens in top of penis rather than the tip | Assoc w dorsal chordee (penis curves up) and rarely with bladder exstrophy

Question 326

When do you intervene surgically in an umbilical hernia

Answer 326

If it persists beyond 2 years of age (under 2 years it should resolve spontaneously)

Question 327

What is the most common cause for boys needing renal transplant in childhood?

Answer 327

Posterior urethral valve (developmental abnormality) Leads to urinary obstruction -> renal failure

Question 328

Systemic effets of anorexia

Answer 328

Hypotension Arrhythmias Long QT Decr grey matter (reversible) Decr bone density - growth delay/arrest Hypothermia Delayed/interrupted puberty Long term effects on sexual/reproductive health

Question 329

Treatment anorexia

Answer 329

CBT | Maudsley family based treatment

Question 330

Features of ADHD

Answer 330

Developmental problem w deficits in: 1. Inattention 2. Impulsivity 3. Overactivity Tx: - Stimulant medication (ritalin) - Psychosocial/behavioral strategies involving positive parenting, teachers, counselling

Question 331

When does ODD typically present and what os the risk of not treating it? Tx?

Answer 331

Typically surfaces at primary school but can be younger May progress to conduct disorder if untreated Tx: psychological strategies 1. Assess current motivation to change 2. CBT 3. Family interventions

Question 332

IgE vs non-IgE mediated allergies

Answer 332

IgE mediated: - Sx appear within 1-2hrs but typically within min - Sx: hives, urticaria, angeioedema, resp distress ex: tree nuts, raw egg Non-IgE mediated - T cell mediated - Sx appear >2 hours after ingestion - Sx: GI and skin related (vomiting, diarrhoea) - ex: cow's milk allergy, soy milk, rice, FPIES

Question 333

How is a skin prick test conducted?

Answer 333

Allergen introduced under epidermis Measure wheel at 15min Controls: histamine (expect pos) and saline (expect neg) Wheal => 3mm above saline control is positive result

Question 334

Indications for food challenge

Answer 334

– Non-IgE mediated – IgE mediated BUT low suspicion of allergy w uncertain history w +ve SPT/RAST (serum specific IgE) w OR good history w -ve SPT/RAST

Question 335

High risk groups for anaphylaxis

Answer 335

□ HX anaphylaxis □ Multiple food and drug allergies □ Poorly controlled asthma □ Underlying lung disease

Question 336

What is FPIES

Answer 336

Type of non-IgE mediated food allergy Food protein induced enterocolitis syndrome - occurs in infants and young children - profuse vomiting and diarrhoea 2-4 hours after first exposure to allergen

Question 337

Mx of allergic rhinitis

Answer 337

Avoidance/ reduction measures Drugs: oral antihistamines (end gen), intranasal corticosteroids (fluticasone) Allergy immunotherapy

Question 338

What are the 4 types of child abuse?

Answer 338

``` Physical Emotional Neglect Sexual +/- family violence witnessing ```

Question 339

What do you do if you suspect child abuse?

Answer 339

Mantatory reporting if you have reasonable grounds to suspect it is causing harm to child and parents have failed or are unlikely to protect them. Look up number to call on child protection website. 'Child FIRST' referral

Question 340

What sort of injuries might indicate child abuse?

Answer 340

Bruising (esp on buttox, ears and peri-orbital) Posterior rib fractures and epicondylar fractures from shaking

Question 341

DDX midline neck lump in a child

Answer 341

1. thyroglossal cyst (will elevate on protrusion of tongue and swallowing) 2. Thyroid lump 3. Thymus lump

Question 342

Features of psoriasis in children - Appearance - Location - Complication(s)

Answer 342

□ Deep salmon red colour, silver scaly plaques Commonly on extensor surfaces, scalp, nails, umbilicus In childhood get more post-strep guttate pattern on trunk Complications: arthritis (1/10)

Question 343

What is tinea and what is it's typical appearance?

Answer 343

Tinea is ringworm. fungal infection. | Typical appearance is spreading ring rash

Question 344

What virus causes roseola?

Answer 344

Human Herpes Virus 6 and 7

Question 345

Systemic complications of port-wine stain birth

Answer 345

CCF Brain PHACES Hypothyroid

Question 346

Possible causes of hair loss in kids

Answer 346

Alopecia Areata (autoimmune hair loss in patches) Tinea Wapitis (focal hair loss w underlying scaly erythematous lesions)

Question 347

Treatment of atopic eczema

Answer 347

Face - topical hydrocortisone and steroid-sparing medications (weaker) Body - topical methylprednisilone (stronger) Regular emollients Treat secondary infection (ex: staph) Identify and remove any potential allergens and irritants

Question 348

Treatment of psoriasis (3)

Answer 348

1. Topical - Keratolytics (salicylic acid) if scaly - Steroids - Emollients - Vitamin D and A (retinoids) 2. Phototherapy in older kids not responding to steroids 3. Systemic (difficult, severe, resistant cases) - Retinoids (vit A) - Methotrexate

Question 349

ABCs of a paediatric behavioural history - red flags of each

Answer 349

Antecedent (trigger) - Red flags: no clear/reasonable trigger, occurring in multiple environments Behaviour - Red flags: developmentally inappropriate, regression, multiple concerning behaviours * ASK SPECIFICALLY ABOUT: eat, sleep, play* Consequences (what happens after; how does this affect the child and those around them and functioning) - Red flags: harmful to self and others, affecting functioning of child and/or family

Question 350

What do you suspect if a baby has a massively distended abdomen AT BIRTH - hasn't passed meconium - vomiting bile What if they were only distended a day or 2 after birth?

Answer 350

Distended at birth: think meconium ileum in a child w F Distended a day or 2 after birth: think - distal bowel obstruction (anorectal anomalies/imperf anus) - hershsprung's disease (rectal stimulation will give sudden gush of merconium)

Question 351

What condition is duodenal atresia associated with? How would this present?

Answer 351

30% risk of down syndrome w duodenal atresia Bowel obstruction WITHOUT distended abdomen (empty hypogastrium with distended epigastrium dye to duodenal/jejunal obstruction) in a nutritionally deficient baby (thin, pale, ribs visible)

Question 352

Classic x-ray finding of duodenal atresia

Answer 352

Double bubble sign - distended stomach and duodenum separated by pyloric valve (Have complete closure of portion of lumen of duodenal so get ballooning of lumen proximal to this)

Question 353

What is hirschsprung's disease?

Answer 353

A form of megacolon occurring when part or all of large intestine have no ganglion cells therefore are in constant state of contraction, causing distal bowel obstruction Presentation: failure to pass meconium within 48 hours od devilry +/- abdo distension, vomiting, explosive stools following rectal stimulation, bloody diarrhoea

Question 354

What do you suspect in a baby who is unable to swallow and is constantly dribbling/drooling saliva? How do you examine for this?

Answer 354

Oesophageal atresia (drooling baby until proven otherwise) Passing catheter through mouth and seeing how far it travels will establish whether oesophagus is non-patent or not

Question 355

What BMI percentile cut off qualifies as FTT? Overweight? Obese?

Answer 355

<5th centile: FTT 85-95th centiles: overweight >95th centile: obese

Question 356

Features of turner syndrome

Answer 356

XO karyotype - Short girl relative to family - Pubertal failure - Webbed beck - hearing, renal defects - CHD, HTN

Question 357

Endocrine causes of short stature

Answer 357

Hypothyroid most commonly (elevated BMI, constipation, sluggish behaviour etc) Cushing's disease (GC excess) - elevated BMI GH deficiency

Question 358

What is a form of skeletal dysplasia and how is this generally picked up?

Answer 358

Achondroplasia (dwarfism) - Autosomal dominent, picked up antenatally on ultrasound

Question 359

Red flags for investigating short stature

Answer 359

abnormal growth velocity signs of chronic disease on systems review/exam abnormally short for family <1st centile Obvious dysmorphic/syndromic features

Question 360

What is the definition of failure to thrive?

Answer 360

Failure to thrive is being <3% for weight or dropping 2 or more percentile tracks

Question 361

what are the three main complications in kids of renal failure?

Answer 361

Anaemia Metabolic bone disease (renal osteodystrophy and hyperparathyroidism) Poor growth

Question 362

what is haemolytic uraemia syndrome?

Answer 362

microangiopathic

Question 363

What is the most common cause of AKI?

Answer 363

Pre-renal cause (hypo perfusion due to septic shock, hypovolaemia, haemmhorage, severe dehydration etc)

Question 364

Which electrolyte reflects water balance in the body?

Answer 364

[Na] w normal range 135-145mmol/L [Na] high: dehydrated [Na] low: over-hydrated

Question 365

What is a severe complication of SiADH? Around what [Na] does this occur?

Answer 365

Water retention from ADH release -> Cerebral oedema -> raised ICP -> hyponatraemic encephalopathy and brainstem herniation Occurs around [Na] 120 in kids

Question 366

What are the clinical signs of dehydration and what % body weight of fluid is lost with each? - Mild - Moderate - Severe

Answer 366

Mild (<4%) -none Moderate (4-6%) - delayed cap refill - increased RR - mildly decr tissue turgor - sunken eyes and fontanelles - oliguria/decr wet nappies Severe (>=7%) - cap refill >3sec - mottled skin - irritable, decr conscious state, hypotensive - deep, acidotic breathing - decr tissue turgor

Question 367

How do you evaluate fluid status in a child?

Answer 367

Daily weights (Loss of body weight in g = estimated fluid deficit in ml) Fluid charts (daily intake and losses) Daily UEC and BSL monitoring Clinical signs

Question 368

When replacing a fluid deficit, over how long should you replace that deficit?

Answer 368

Over 24 hours | UNLESS they are hypo or hypernatraemic, then replace over 24-72 hours

Question 369

Why is NGT preferred over IV rehydration in kids?

Answer 369

Less likely to cause electrolyte imbalances

Question 370

What fluid do we use for rehydration in children and neonates?

Answer 370

Children: normal saline with 5% dextrose Neonates: normal saline with 10% dextrose

Question 371

What is the 4/2/1 rule of fluid resus? When might you stray from this and why?

Answer 371

First 10kg body weight: 4ml/kg/hr Second 10kg: 2ml/kg/hr Over 20kg: 1ml/kg/hr 1/2 or 2/3 maintenance for kids w severe illness due to SiADH causing fluid retention (meningitis, encephalitis, head trauma, surgery, resp issues)

Question 372

What can happen if serum [Na] changes too rapidly?

Answer 372

Cerebral oedema, seizures and permanent brain damage Central pontine myelinosis occurs as a consequence of a rapid rise in serum tonicity following treatment in individuals with chronic, severe hyponatremia

Question 373

What referral(s), if any, would you give a chid w school-based learning and behaviour problems?

Answer 373

Educational psychologist to test: - Vision - Hearing - Cognitiion

Question 374

When do you refer for speech therapy and audiology assessment?

Answer 374

<50 words at 2yo No 2 word combinations at 2.5yo No understanding of simple instructions without gesture

Question 375

Differentials for an irritable baby who is sleeping poorly

Answer 375

Colic GORD/physiological reflux Poor maternal/child relationship Cow's milk protein allergy

Question 376

Features of colic

Answer 376

``` PURPLE CRYING Peaks at 6-8 weeks Unexpected Resists soothing Pain-like face Long-lasting (crying for >5 hours a day at times) Evening (sleep deficit is at peak) ```

Question 377

When might a child have lactose intolerance?

Answer 377

Never BORN with lactose intolerance - all kids under 3 have high levels of lactase. They may only have it secondary to coeliac, IBD, giardiasis, CMPA which destroy the intestinal brush border which attaches to lactase

Question 378

What may the presentation of CMPA be? What are the rates of resolution?

Answer 378

Regurgitation, vomiting after feeds Stool changes (diarrhoea/constipation, blood) Skin/eczematous rash FHX atopy 50% resolve by 1yo; 80% by 3yo

Question 379

Management of physiological reflux in infants

Answer 379

Raise head of head Thicken formula Omeprazole is just a bandaid - decreases acidity but doesn't prevent reflux.

Question 380

What is the character and location of a pulmonary flow murmur?

Answer 380

Pulmonary area +/- radiation to axilla Soft blowing ejection systolic murmur

Question 381

Systolic murmurs in kids | ejection vs pan systolic

Answer 381

Ejection: - innocent pulmonary flow murmur - AS - PS - Bicuspid aortic valve Pan systolic: - MR - VSD

Question 382

Diastolic murmurs in kids Early Mid Late

Answer 382

Early: - AR - Pulmonary Regurg Mid - MS - Large VSD Late - MS (with atrial contraction)

Question 383

What does APGAR stand for?

Answer 383

Appearance (colour) - pale or blue/body pink extremities blue/pink Pulse rate - absent/<100/>100 Grimace (reflex irritability) - none/some/vigorous, cry Activity (tone) - floppy/some flexion/good flexion Respiratory rate - apnoeic/irregular/active crying

Question 384

Where do you place the SaO2 probe on neonates and what does this represent?

Answer 384

R hand or wrist | = pre ductal pulse oximetry

Question 385

When is peak surfactant produced in babies and below what age is it not enough to keep alveoli patent?

Answer 385

Peak at 37 weeks (term) Not enough surfactant to keep alveoli open below 32 weeks

Question 386

risk factors for hypoglycaemia in neonates

Answer 386

Maternal/gestational diabetes Delay in feeding Preterm Growth retarded and sick infants

Question 387

What affect does prematurity have on the kidneys?

Answer 387

Kidneys are unable to reabsorb phosphate which results in demineralisation of bones in order to increase serum [Ph]

Question 388

How do you test for bone disease of prematurity Mx?

Answer 388

Ix: test blood ALP and urine Phosphate levels Mx: Ph and Ca supplements

Question 389

When do you expect each of the following shunts to close: 1. Ductus venous 2. Foramen vale 3. Ductus arteriosus

Answer 389

1. Ductus venosus - Over 3-7 days 2. Foramen ovale - Functionally closes in first few breathes of life (but is not fully closed in 50% children by 5yo) 3. Ductus arteriosus - 3-4 days in 95% term babies

Question 390

Causes of apnoea in premies

Answer 390

1. Apnoea of prematurity is most common in otherwise well bubs (caffeine as Mx) 2. Infection (empirical antibiotics until infx is ruled out!) - lung disease - hypoxia - academia - drugs - metabolic disturbances (hypoglycaemia, hypocalcaemia, hyper/hypomagnasaemia) - Intracranial haemmhorage - polycythaemia w hyperviscosity - Necrotising enterocolitis - CHD (PDA)

Question 391

RFs for prematurity

Answer 391

1/2 of premature births don't have RFs 1. Maternal factors - previous preterm - extremes of maternal age - low pre-pregnant weight/malnourished - acute illness - pre-eclampsia/eclampsia - previous miscarriage or termination of pregnancy - HX infertility - IVF 2. Fetal factors - fetal anomalies - polyhydramnios 3. Placenta and membrane difficulties 4. Social - Low SES - psychological stress - Alch, drugs, smoking

Question 392

Complications of prematurity (acute)

Answer 392

Resp - RDS/HMD - apnoea of prematurity Cardiac -PDA Neurological - intraventricular haemmhorage - periventricular leukomalacia - Cerebral palsy Hepatic - Hypo/hyperglycaemia - Jaundice Renal - Bone disease of prematurity - electrolyte imbalances (hypo/hypernatraemia, hyperkalaemia, metabolic acidosis) GI - feeding difficulties - NEC Infection due to immature immune system Temp instability

Question 393

Late/chronic effets of prematurity

Answer 393

Delayed growth (usually catch up Retinopathy of prematurity Chronic lung disease of prematurity Neurodevelopment delay (CP, blindness, deafness)

Question 394

Most common cause for IUGR?

Answer 394

placental compromise

Question 395

Gross Motor milestones

Answer 395

Head lag minimal at 6-8 weeks Rolling at 3-5 mo Sitting at 6 months Crawling at 9 mo Walking at 12 mo Jumps BY 3 years Balances on one foot BY 4.5 years

Question 396

Red flag for gross motor

Answer 396

Not walking by 18mo

Question 397

Fine motor milestones

Answer 397

Palmar grasp by 6mo Inferior pincer by 9mo Pincer grip, stacks 2 cubes ~ 12mo Handedness 18mo Spontaneous scribbling by 2years Imitates vertical line by 3 years Copies face/ladder by 4.5 years

Question 398

Social and daily living skills milestone red flags

Answer 398

No interest in other children/help w dressing at 24 months NO interactive play with peers at 3 years No imaginative role play by 4 years

Question 399

Paracetamol overdose treatment in kids

Answer 399

1. If dose ingested is possibly >10g or >200mg/kg, start NAC 2. measure paracetamol concentration 4 hours post-ingestion 3. If above treatment threshold, continue NAC 4. repeat paracetamol concentration, UECs, LFTs on completion.

Question 400

Main infectious agents of cellulitis Ix Mx

Answer 400

S aureus and Strep progenies (consider HIB in unimmunised children <5yo) Ix: blood cultures Mx: Flucloxacillin po or IV if fever, rapid progression +/- ceftriaxone to cover HIB if unimmunised, <5yo

Question 401

What is Prader-willi syndrome?

Answer 401

Behaviourial/developmental disability featuring food seeking, ODD and OCD, mild features of ASD as children - incr risk of psychosis, T2DM, OSA, scoliosis as adults Excessive appetite and lack of satiety -> risk of obesity Genetic - loss of paternally expressed genes

Question 402

Features of autism

Answer 402

1. Problems w socialisation - poor eye contact - difficulties w gestures - not responding to name - failure to socialise w others 2. Problems w communication - limited use of language - no imaginative play or social imitative play 3. Repetitive or obsessive behaviours - repetitive play - inflexible, repetitive use of language - unusually obsessions w inflexible and limited interests - self-stimulating behaviours (toe walking, hand flapping, jumping in place, making sounds, grinding teeth etc)

Question 403

What is 'croup'? Presentation Aetiology MX

Answer 403

Laryngotracheobronchitis Presentation: barking cough +/- stridor on exertion (at rest = severe) Aetiology: Parainfluenza Mx: supportive treatment for most kids - If stridor at rest, single dose of oral DEX then Observe for half an hour post steroid administration. Discharge once stridor-free at rest. - If severe: O2, IM/IV dex, neb adrenaline, intubation or tracheostomy If good improvement, observe for 4 hours post adrenaline. Consider discharge once stridor free at rest. If deterioration/no improvement, give further adrenaline and consider admission or transfer as appropriate.

Question 404

Complications of viral URTIs

Answer 404

- Otitis media - Acute sinusitis - Bacterial superinfection - Progression to LRTI (bronchitis, croup, bronchiolitis, pneumonia) - Asthma exacerbation

Question 405

What are the bag bugs you have to watch out for that can cause pharyngitis? Defining features

Answer 405

1. EBV - exudative tonsillitis assoc w cervical lymphadenopathy and generalised flu-like SX 2. HSV-1 Mucosal ulceration 3. Enteroviruses (Coxsackie A/B, echoviruses) - assoc w oral ulcers and rash 4. Strep throat (pyogenies) - exudative tonsilitis, strawberry tongue, widespread erythematous rash, tender enlarged cervical lymph nodes, high fever

Question 406

Presentation: bilateral swelling, tenderness, pain in parotid glands What is the diagnosis?

Answer 406

Mumps.

Question 407

Most common causative agent of acute otitis media. What would you see on ear exam? How do you treat?

Answer 407

Strep pneumonia most common (H. influenza and moraxella catarrhalis) See red bulging TM, presence of middle ear fluid Analgesics. Limited value in treating w antibiotics as pain resolves in 2-7days

Question 408

Maintains of MX of URTIs

Answer 408

- self-limiting and don't require pharm. intervention unless they are complicated - influenza and pneumococcal vaccine as prevention - reduce exposure to tobacco smoke - hygiene to reduce transmission rates

Question 409

Features of asthma SX Signs

Answer 409

SX: Wheeze and SOB Responsive to salbutamol Chest tightness, coughing (worse at night and in morning) Signs: - tracheal tug, WOB - prolonged exp. phase - exp wheeze - tachypnoea - decr RR and absent wheeze, decr breathe sounds in severe asthma

Question 410

Asthma management plan (and what features define each stage?) 1. mild 2. moderate 3. severe 4. critical

Answer 410

1 dose salbutamol: 6 puffs if <6yo or 12 puffs if >6yo 1. mild: 1 dose salbutamol and review after 20min. If good response, D/C on salbutamol PRN. Poor response, treat as moderate 2. Moderate (incr WOB, disrupted sentences, tachycardia): Salbutamol 1 dose every 20min for 1 hour. review 10-20 min after 3rd dose to determine freq of next dose. O2 if saO2<92% 3. Severe (agitated/distressed, marked WOB and limitation of speaking ability): Salbutamol 1 dose every 20min for 1 hour -> if responding, incr time between doses. If not responding, continue dosing even 20min. + o2 as above. +/- atrovent via MDI/spacer every 20min for 1 hour only. +/- IV Mg sulfate +/- IV aminophylline 4. Critical (silent chest, confused/drwosy, no talking) - O2 - Continuous nebuliser salbutamol - Nebulised iprotropium (3x in 1st hour only) - IV methylpred - IV Aminophylline and MgSulfate +/- ICU admission + 3 days oral pred with each (2mg/kg `day 1 then 1mg/Kg day2,3)

Question 411

Signs of salbutamol toxicity?

Answer 411

Tachycardia, tachypnoea, metabolic acidosis. Can occur with both IV and inhaled therapy. Lactate commonly high.

Question 412

Stridor -differentials - Inx?

Answer 412

Acute - most common acute cause in kids is CROUP - retropharyngeal abscess - peritonsillar (quinsy) abscess - laryngeal trauma Persistent - laryngomalacia most common cause of persistent stridor - subglottic stenosis - subglottic haemangioma INX: only if stridor is persistent with an expiratory component (severe) = bronchoscopy

Question 413

Differentials for wheeze

Answer 413

Since birth: - airway malacia (tracheomalacia or bronchomalacia) Gradual onset SX - Asthma - Recurrent viral-induced wheeze - Cystic fibrosis - Cardiac causes Sudden onset SX - LRTI (bronchiolitis, viral pneumonitis, bacterial bronchitis) - Inhaled foreign body

Question 414

RF for TB infection

Answer 414

``` Emigrants from developing countries Low SES Indigenous Immunodeficiency <5yo ```

Question 415

Chronic cough DDX and first line IX

Answer 415

Asthma Viral or bacterial URTI or LRTI Cardiac (pulm HTN, pulm oedema) Bronchiectasis (CF, primary ciliary dyskinesia, immunodeficiency, foreign body etc) Aspiration Chronic/less common infx (Tb, pertussis, mycoplasma, atypical pneumonia) Interstitial lung disease (rheumatic diseases, cytotoxic, drugs, radiation) GOR Psychogenic FIRST line Ix: CXR and spirometry if >6yo

Question 416

Presentation of bronchiectasis

Answer 416

□ Chronic moist or productive cough, WORSE in mornings □ Clubbing □ Chest wall abnormalities (hyperinflation, pectus carinatum) □ Inspiratory creps

Question 417

Mx of cystic fibrosis

Answer 417

1. Antibiotics to reduce bacterial colonisation and biofilm formation of resp tract 2. Physio to promote mucociliary clearance 3. Vaccines: pneumococcal and influenza 4. High energy diet and pancreatic supplements (Creon) 5. Vitamin and salt supplements +/- lung and liver transplants at end-stage

Question 418

DDX diarrhoea

Answer 418

Osmotic - IBS - Laxatives Secretory - Gastro (ETEC, cholera) Inflammatory - IBD - Surgical (appendicitis, interception) - Sepsis, UTI - NEC Motility - Hyperthyroid - Diabetic neuropathy Malabsorption - Coeliac - Cystic fibrosis - Giardia - CMPA

Question 419

Red flags for diarrhoea

Answer 419

SX of Dehydration (dizzy, decr urine output, lethargic) Prolonged diarrhoea Blood in stool Systemically unwell FTT Bilious commits Acute abdo (severe abdo pain and tenderness)

Question 420

When do do a renal U/S for kids w UTIs

Answer 420

If <6mo: U/S during acute infection if atypical UTI or recurrent UTI OR within 6 weeks if responds to treatment within 48 hrs If >6mo: U/S during acute infection if atypical UTI only OR within 6 weeks if recurrent UTI only . If responds to treatment within 48 hrs no need for imaging.

Question 421

Features of atypical UTIs

Answer 421

- Seriously ill/septicaemia - Poor urine flow - Abdo or bladder mass - Raised creatinine (deranged renal fun) - Failure to respond to Ab treatment within 48 hours - Non-ecoli isolated

Question 422

Acute management of UTIs

Answer 422

<3mo: IV antis >3mo, pyelo/upper UTI: PO cephalosporin or augmentin (7-10days) >3mo, cystitis/lower UT: PO cephalosporin, trimethoprim (3 days)

Question 423

Causes of non-blanching rashes

Answer 423

Viral most common (but higher % bacterial than w blanching rashes) - enterovirus, influenza ``` N. Meningitidis Other bacteria (Strep pneumonia, HIB) ``` HSP, ITP, DIC Leukaemia Mechanical trauma

Question 424

Causes of blanching rashes

Answer 424

``` VIRAL most common cause Enterovirus Adenovirus Coxsachie virus Rhinovirus RSV Measles Parvovirus B19 (itchy) Bacterial - toxic shock syndrome ```

Question 425

How does parvovirus cause fetal anaemia?

Answer 425

bone marrow suppression which decr production of erythrocytes

Question 426

what about fevers can cause febrile convulsions?

Answer 426

Rate of temp rise rather than the degree of temperature itself

Question 427

Steven Johnson syndrome results due to what causes? what is the classic presentaiton

Answer 427

Flu-Like symptoms as prodrome followed by red/purple rash that spreads and forms blisters (skin, mucous membranes, genitals, eyes) Main cause: mycoplasma infection - drug reactions (anti epileptics) -

Question 428

Causative agents of osteomyelitis/septic arthritis Management?

Answer 428

Staph aureus #1!! Strep pyogenies and haemophilus influenzae Mx: 1. REFER TO ORTHO for aspiration +/- athrotomy and washout 2. IV fluclox 3. Elevate and immobilise limb

Question 429

Rule of 2s of Meckel's diverticulum

Answer 429

``` 2% population 2:1 male:female 2 feet above ileocecal valve 2 inches long 2% patients develop complications over lifetime, typically before age of 2. ```

Question 430

How can mocker's diverticulum present?

Answer 430

``` Abdo pain (Related to bowel obstruction, Meckel's diverticulitis or perforation) GI bleeding SX of bowel obstruction ```

Question 431

What does a high reticulocyte count indicate? | Low reticulocyte count?

Answer 431

® Incr -> indicates marrow response to ?haemolysis ® Decr -> indicates lack of marrow response -> ? Deficiency in necessary iron or vitamins OR ? Inability to respond (marrow aplasia or infiltration)

Question 432

Causative agents of osteomyelitis/septic arthritis Management?

Answer 432

Staph aureus #1!! Strep pyogenies and haemophilus influenzae Mx: 1. REFER TO ORTHO for aspiration +/- athrotomy and washout 2. IV fluclox 3. Elevate and immobilise limb

Question 433

Rule of 2s of Meckel's diverticulum

Answer 433

``` 2% population 2:1 male:female 2 feet above ileocecal valve 2 inches long 2% patients develop complications over lifetime, typically before age of 2. ```

Question 434

How can meckel's diverticulum present?

Answer 434

``` Abdo pain (Related to bowel obstruction, Meckel's diverticulitis or perforation) GI bleeding SX of bowel obstruction ```

Question 435

What is HUS?

Answer 435

STEC (also known as VTEC) infection can cause bloody diarrhoea, fever, abdo pain, vomiting and sometimes haemolytic uraemic syndrome. Infection usually results from consuming contaminated food or water, or from contact with infected animals or people. HUS is a severe condition characterised by kidney failure, bleeding and anaemia. It can sometimes be fatal. -> bruising/petechial rash (low Plts), haemolytic anaemia, reduced consciousness, reduced urination, HTN, seizures.

Question 436

Definition of failure to thrive

Answer 436

Infant's weight below 3rd centile or >2SD below population mean Weight crossing 2 major centile lines with time

Question 437

Risk factors for FTT

Answer 437

Prematurity | IUGR

Question 438

Causes of FTT | What 2 are most common

Answer 438

Reduced intake (most common) 1. Inadequate caloric intake (poor feeding etc) 2. Psychosocial - maternal depression/poor maternal-child bond - difficulties at home Incr metabolism - Chronic or intercurrent illness, infections (UTI, Thyroid, CF, CHD, CRF, chromosomal, atopy, Tb, HIV etc) Reduced nutrient absorption - Coeliac - CMPA - IBD

Question 439

What are some methods of increasing caloric intake in infants with FTT

Answer 439

Dietary advice and monitoring Breast-fed infant: Supplementing breastfeeds with EBM or formula afterwards Formula-fed infant: - Increase forumla concentration or add glucose polymer (extra calories) to bottle - introduce solids or add calories to solids

Question 440

Indications for an epipen

Answer 440

- anaphylaxis - also has asthma as well as allergy - geographical distance from emergency medical services

Question 441

Indications for Food challenge

Answer 441

- uncertain HX | - borderline skin prick testing (~3mm)

Question 442

What organism causes meningococcaemia? What is different about managing this condition as a cause for sepsis and/or meningitis?

Answer 442

Neisseria Meningiditis Notifiable disease! - patient req isolation until 12hours IV antis - notify the Department of Human Services - Rifampicin prophylaxis to all close contacts (household, day-care, intimate relations in pst 7 days)

Question 443

Emergency management of severe anaphylaxis

Answer 443

Adrenaline - 0.5mc Adrenaline IM, give every 5 min if not responding Airway - intubation + neb adrenaline if required +/- oral corticosteroids and nebulised salbut for bronchospasm B - high flow O2 C - circulation (supine w legs elevated to prevent collapse) Exposure - H2 antagonists for skin involvement

Question 444

DX and MX of eosinophilic esophagitis

Answer 444

DX: gastroscopy and biopsy histology MX: food avoidance (dairy, wheat, egg, soy triggers), swallowed aerosolised CS

Question 445

Emergency fluid rhesus in shocked patients

Answer 445

Give boluses of 10-20ml/kg of 0.9% sodium chloride (normal saline), which may be repeated once (Give second 20ml/kg bolus if required to a total vol of 40ml/kg) ® If persisting hypotenseion after second bolus, give inotropes (Adren/NA in 500ml 0.9% normal saline)

Question 446

Prophylactic antibiotics for sepsis

Answer 446

<1mo: benpen and cefotaxime | >1mo: flucloxacillin and ceftriaxone

Question 447

What is HSP and how does it typically present?

Answer 447

Most common vasculitis of childhood Purpura + abdo pain + arthralgia +/- renal involvement (haematuria/proteinuria/hypertension) Often preceded by viral URTI

Question 448

Dx and Mx of HSp

Answer 448

Dx: urine test Mx: supportive (paracetamol +/- NSAIDs, oral or IV corticosteroids relieve joint and abdo pain)

Question 449

features of colic

Answer 449

Completely benign, normal part of development ``` Peaks at 2 months (Begins: 2 weeks of age and continues until about 3-4 months of age). Unexpected Resists soothing (INCONSOLABLE crying) Pain-like face Long-lasting (up to 5 hours of crying) Evening ```

Question 450

Newborn that appears normal but has resp distress when NOT crying. Pink when crying but makes vigorous resp efforts and becomes dusky when stops crying. What is the likely explanation and how would you diagnose this?

Answer 450

Choanal atresia. Infants are obligate nose breathers until 4 months of age - choanal atresia occurs when an infant has a structurally non-patent nose. DX by inability to pass a feeding tube through nostril or clouding of cold metal under infant's nose?

Question 451

Contraindications to vaccines

Answer 451

Known allergy to ingredient Previous anaphylaxis Immunocompromised