Paeds Cases Mx

Question 1

Nephrotic Syndrome

Answer 1

Proteinuria
Hypovolemia
Infection & Autoimmune
HLD
Coagulopathy & DVT
Infections
Growth
Steroid complication
Immunomodulator complication
Renal Failure

Lifestyle mx
Pharmacological

Question 2

Asthma mx

Answer 2

Symptoms
Treatment
Control (day 2/w, any noc, reliver>2, PEF FEV1<80% + BD response 200ml >12%)
Atopy
Invx (Spiro, SPT, PEFR, CXR)
Infection, allergens (carpets, smoke)

Steroids
Education (technique, delivery device)
Avoidance
Stepwise control
WAAP
Atopy

Acute exacerbation:
Salb neb:
a. child: 0.03ml/kg + 2ml NS; repeat 2x
b. Adult: 1ml(5mg):2ml ipra: 2ml NS;
Steroids:
PO pred 0.5-1mg/kg max 50mg; IV hydrocort 100mg

Non responsive
IV MgSO4
repeat neb
Adrenaline 0.3-0.5ml 1:1000

Question 3

Hematuria

Answer 3

Upper Tract - color; proteins;

Lower tract - LUTS; freq urgency
Urine quality

Stones or infection; tumor
Nephritic syndrome

Question 4

IBD mx

Answer 4

Abdo pain, diarrhea, stools
Perianal - fissures, fistula; tenesmus
Growth & Nutrition (vit D deficiency)
Ortho (arthritis, AS; Jt swelling)
Anemia
Cutaneous ENodosum; Pyoderma
Occular
Hepatic

Biochemical (liver, nutrition, FBC, ESRCRP)
Serology ASCA ANCA
Stool CS, OCP, calprotectin

Bone
AXR
US - abscess, thickening
CT - abscess, fistula, stricture

Endoscopy OGD colonscopy + biopsy
a. cobblestone; skin lesion, stenosis strictures
b. continuous inflammation, sharp demarcation, erythema, pseudopolyps, islands of sparing

Lifestyle therapy;
Nutrition EEN
Induction: Steroids
Maintenance
Abx (fitulas)
surgical - segmental resection; whole resectin + anastamosis
Cancer

Question 5

CP mx

Answer 5

Neuro:
Seizure
learning disability
Swallowing; aspiration; pneumonia
muscle relaxation

Hearing
Vision

GI: constipation; drooling

Ortho:
jt deformity ; contractures
scoliosis
mobility

Question 6

Bil Atresia mx

Answer 6

NNJ
Obstructive jaundice
FTT

Dx
UC 20%;

Mx :

Kasai

Question 7

Seizure mx

Answer 7

Acute mx
Status epilepticus ; first lines x2; 2nd line;

Typical atypical
Febrile
Meningitis encephalitis
Electrolytes
Trauma
Neoplastic

Epilepsy Syndromes
CP; Neurocutaneous;

Breakthrough seizure

Meds
BZDs; AEDs
SV

Question 8

Nephritic Syndrome mx

Answer 8

HTN
Hematuria; oliguria
LUTS

Causes; -

Question 9

Recurrent UTI

Question 10

Spina Bifida

Answer 10

Weakness & paralysis
Incontinence
Recurrent UTIs - MCU, DMSA
arnold chiari - VP shunt

Development
contractures
genetic counselling

Question 11

CLD

Question 12

Obesity

Question 13

T1DM

Answer 13

DKA: AMS; abdo pain; dehydration; SOB
Sx LOW
Hypoglycemia

Growth; FTT;

Complication:
macro and micro; screens
DRP DFS
Assoc autoimmune

Diagnosis;

Meds: time taken

Management:
Diet monitoring
Insulin - advice and sick day plan;
Lipodystrophy;
Hypogly

Question 14

Thal

Question 15

Pneumonia

Question 16

Eczema

Question 17

JIA

Question 18

SLE

Question 19

DMD

Answer 19

XLR; Becker has ater onset (2-5y vs 15y); milder course
loss of dystrophin gene - affects muscle protein structure - muscle necrosis replacement with connective tissue and adipose

prox weak; motor regression
cognition
Ortho - contracutre; scoliosis; osteoporosis
GI: constipation, urinary retention

CVS - dilated cardiomyopathy; arrhythmia; heart failure

recurrent pneumonia

Growht & ADLs
Psychosocial

Lower limb - pseudohypertrophy wasting; contracture
TRP
Gower; tiptoe or waddling gait

Spine - lumbar lordosis
Respi pneumonia

CK, alodolase
Gene analysis
Muscle biopsy - absent dystrophin vs reduced (BMD); fibre diameter change

Education; PT respi + contractures; ventiation nutrition
Steroids - pred

Question 20

Paeds cardiac murmur; general grouds

Answer 20

PSM; MR TR, VSD
ESM: AS, PS, HCM, ASD
EDM: AR PR
MDM: MS, TS, AF

apex; radiates axilla; expiration; MR
MDM; apex; turning; opening snap; MS

PSM; LLSE; JVP - TR/VSD (loud P2 from pHTN + MDM apex)

ESM; fixed splitting; ULSE; - ASD
ESM; ULSE; back radiation; inspiration; loud S2 - PS/ToF - pink

EDM; URSE/L sternal border; expiration, bending forward, collapsing pulse - AR
ESM; carotids; slow rising pulse - AS
PSM/continuous; back between scap; RF delay - CoA

Continuous;
PDA - L clav
BT shunt -

Question 21

PSMs

Answer 21

PSM; MR TR, VSD

apex; radiates axilla; expiration; MR

PSM; LLSE; JVP - TR/
VSD (loud P2 from pHTN + MDM apex; th)

VSD

Question 22

ESMs

Answer 22

ESM: AS, PS, HCM, ASD

ESM; carotids; slow rising pulse, thrusting apex, expiration- AS

ESM; ULSE; back radiation; inspiration; loud S2 - PS/ToF - pink

ESM; fixed splitting; ULSE; - ASD

Question 23

EDMs

Answer 23

AR - collapsing pulse, bounding pulse, forward expiration

PR -

Question 24

MDMs

Answer 24

MDM: MS, PS, AF

MDM; apex; turning; opening snap; MS

PS - ESM; ULSE; back radiation; inspiration; loud S2 - PS/ToF - pink
CCF, pHTN

Question 25

Cyanotic CHDs

Answer 25

ToF TPA Tricuspid atresia

Question 26

Complications of valvular disease

Answer 26

P HTN (loud P2, lpalation, P sternal) CHF: SOB, cyanosis, edema, creps, S3 Endocardiits

Question 27

Continuous murmur

Answer 27

PDA - machine murmur CoA - radiates to back BT - lateral thoractoy score

Question 28

Cardiac murmur hx & mx

Answer 28

infant - sweat, feed, infection, FTT older - SOB, exericse, palp, cp birth/maternal PE: centile, BP O2 RD dysmorph, liver clubbing Echocard

Question 29

innocent murmur characteristic and types

Answer 29

soft, sys, sx no, normal S2 split, no radiation, varies with posture and respi venous hum R clav, PSM, forward; continuous murmur, stills - Soft systolic, LLSE; flow murmur; musical; pulm flow - ULSE, soft blowing murmur ESM, grade 2 or softer

Question 30

Turner syndrome

Answer 30

short, cub valgus webbed shield; wide BP, strabismus, cataracts, goitre DM Osteoporosis (scoliosis or #) AS bicuspid CoA HTN Echo FSH, LH TFT glucose Renal US Opthal