Miscellaneous Flashcards
Differential of swelling in groin
-Hernia:
=Protrusion of viscus or part of a viscous outside its containing cavity
=Groin swelling, reducible or irreducible, cannot get above it
=Does not usually trans illuminate unless under 1 year, bowel is thin)
=Elective repair (unless incarcerated), timing varies depending on age of patient
==Children presenting in the first few months of life are at the highest risk of strangulation and the hernia should be repaired urgently. Children over 1 year of age are at lower risk and surgery may be performed electively.
-Hydrocele:
=Abnormal collection of serous fluid surrounding the tunica vaginalis of the testis
=Groin swelling may fluctuate, blueish tinge. Usually presents to adults at bath time (gravity effects)
=Transilluminated
=Elective repair, wait until after 18 months
Problems with hernia
- Obstructed: blockage
- Incarcerated: non-obstructed, cannot push the hernia in, contents of hernia may be trapped
- Strangulated: blood supply affected
Investigations for vomiting
-Obs
-A to E
-IV access: FBC, U+Es, CRP, blood gas
-Fluid bolus ((10mlkg) of 0.9% NaCl followed by 0.9% NaCl 5% Dextrose, 10mmol KCl maintenance rate
-USS, consider AXR for wider differential
-Intussusception?: Target sign
-Bowel obstruction?
-Norovirus, gastroenteritis?
Management of acute abdomen
-Admission
-Fast patient
-Serial re-examination
-Laparoscopic appendicectomy
-Consider US in equivocal
Overview of Juvenile Idiopathic Arthritis
-Arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks. Systemic onset JIA is a type of JIA which is also known as Still’s disease. Pauciarticular JIA refers to when 4 or less joints are affected, 60% of cases.
-P: pyrexia, salmon-pink rash, lymphadenopathy, arthritis, uveitis, anorexia and weight loss. Pauciarticular: joint pain and swelling usually medium sized joints, knees, ankles, elbows), limp, ANA may be positive in JIA associated with anterior uveitis
-I: ANA may be positive, especially in oligoarticular JIA, RF usually negative
Overview of Kawasaki disease
-Type of vasculitis which is predominately seen in children. Whilst Kawasaki disease is uncommon it is important to recognise as it may cause potentially serious complications, including coronary artery aneurysms.
-P: high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics, conjunctival injection, bright red, cracked lips, strawberry tongue, cervical lymphadenopathy, red palms of the hands and the soles of the feet which later peel
-I: Kawasaki disease is a clinical diagnosis as there is no specific diagnostic test.
-M: high-dose aspirin, Kawasaki disease is one of the few indications for the use of aspirin in children. Due to the risk of Reye’s syndrome aspirin is normally contraindicated in children
intravenous immunoglobulin
=Echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms
-Complications
=Coronary artery aneurysm
Common knee problems in children
-Chondromalacia patellae
-Osgood-Schlatter disease (tibial apophysitis)
-Osteochondritis dissecans
-Patellar subluxation
-Patellar tendonitis
Describe chondromalacia patellae
-Softening of the cartilage of the patella
-Common in teenage girls
-Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
-Usually responds to physiotherapy
Describe Osgood-Schlatter disease
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Describe Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
Describe patellar subluxation
Medial knee pain due to lateral subluxation of the patella
Knee may give way
Describe patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Criteria for anaphylaxis
-Sudden onset and rapid progression of symptoms
-Life-threatening Airway and/or Breathing and/or Circulation problems
-Skin and/or mucosal changes (flushing, urticaria, angioedema)
Management of allergy
-Avoidance
-Oral antihistamines
-At risk groups- Adrenaline auto-injectors
-RECOGNITION OF SYMPTOMS: WHEN TO GET MEDICAL HELP
Mild allergic reaction
-Tingling/Oral sensation
-Vomiting
-Urticaria
-Swelling of lips, face, eyes
