Term
| out of possessing and regurg, which one would suggest the presence of GORD? |
|
Definition
|
|
Term
red flag features in vomiting child. what would you think if you saw the following?
bile stained vomit
heamatemesis
projectile vomit in first few weeks of life |
|
Definition
bile stained vomit: intestinal obstruction until proven otherwise
haematemesis: oesophagitis, peptic ulcer, oral/nose bleed
prohectile vomiting: pyloric stenosis |
|
|
Term
red flag features in vomiting child. what would you think if you saw the following?
vomiting at the end of paroxysmal coughing?
abdo pain/tenderness?
abdo distension? |
|
Definition
vomiting at the end of paroxysmal coughing: whooping cough
abdo tenderness/pain: surgical abdomen
abdo distension: intestinal obstruction including strangulated hernia |
|
|
Term
red flag features in vomiting child. what would you think if you saw the following?
hepatosplenomegaly
blood in stool
severe dehydration/shock |
|
Definition
hepatosplenomegaly: chronic liver disease
blood in stool: intususseption, gastroenteritis - salmonella or campylobacter
severe dehydration/shock: severe gastroenteritis, DKA, Systemic infection |
|
|
Term
red flags
bulging fontanelle?
FTT |
|
Definition
bulging fontanelle: raised ICP
FTT: GORD, coeliacs and other chronic GI conditions. |
|
|
Term
| features of intestinal obstruction and vomiting |
|
Definition
the more proximal the obstruction the more prominent the vomiting and the sooner it becomes bile stained.
in distal obstruction abdominal distention is more marked. |
|
|
Term
| list complications of GORD in infants |
|
Definition
FTT from severe vomiting
oesophagitis; haematemesis, discomfort on feeding or heartburn, iron deficiency anemia
recurrent pulmonary aspiration
dystonic neck posturing - SANDIFER syndrome
apparent life threatening events. |
|
|
Term
| what is SANDIFER SYNDROME? |
|
Definition
| involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia. |
|
|
Term
| what kind of infants is severe reflux more common in? |
|
Definition
CP and other developmental disorders
preterm infants esp if co existent with bronchopulmonary dysplasia
following surgery for oesophageal atresia or diagphramatic hernia |
|
|
Term
|
Definition
24 hour pH monitoring to quantify reflux
24 impedance monitoring
endoscopy to exclude oesophagitis |
|
|
Term
|
Definition
parental reassurance
food thickeners e.g. Carobel
position in a 30 degree head up prone position after feeds
if significant reflux: ranitidine or omeprazole
then domperidone
if still present then consider cows milk protein allergy and do further ix.
surgical: nissen fundoplication |
|
|
Term
| features of pyloric stenosis |
|
Definition
projectile vomiting
2-7 weeks peak presentation
> common in boys and first born
hypochloremic, hypokalemic, hyponatremic metabolic alkalosis |
|
|
Term
| what is the surgical rx for pyloric stenosis called? |
|
Definition
|
|
Term
what happens in colic
what are the DDX of colic |
|
Definition
inconsolable crying infant who draws knees up passes a lot of flatus.
typically in first 4 weeks of life. resolves by 4 months
DDX
cows milk protein allergy
GORD |
|
|
Term
| surgical causes of acute abdominal pain |
|
Definition
acute appendicitis
intestinal obstruction
intussusception
inguinal hernia
peritonitis
meckels diveticulum inflammed
pancreatitis
trauma |
|
|
Term
| medical causes of acute abdomen |
|
Definition
gastroenteritis
UTI
HSP
DKA
sickle cell
hepatitis
IBD/IBS
constipation
recurrent abdominal pain of childhood
psychological
lead poisoning
idiopathic |
|
|
Term
| extra abdominal causes of acute abdomen |
|
Definition
upper respiratory tract infection
lower lobe pneumonia
testicular torsion
hip and spine |
|
|
Term
|
Definition
uncommon in children <3 years old
anorexia with low grade fever
few instances of vomiting
central colicky abdo pain that localises to RIF
abdo pain aggravated by movement e.g. walking, coughing jumping, bumps on the road during a car journey
persistent tenderness with guarding in Mcburney's point. |
|
|
Term
what is non specific abdominal pain associated with?
how long does it last before resolving? |
|
Definition
associated with URTI and cervical lymphadenopathy
abdo pain resolves in 24-48 hours. |
|
|
Term
| features of intussusception |
|
Definition
peak 3months and 2 years
paroxysmal severe colicky pain and pallor
infant goes pales esp around the mouth during attacks and draws up legs
initially recover between attacks but then get more lethargic
may refuse feeds, may vomit which can be bile stained depending on site of intussusception
sausage shaped mass often palpable in the abdomen.
red current jelly stools passed is a late sign but characteristic.
abdo distension and shock. |
|
|
Term
| when can you make the diagnosis of mesenteric adenitis? |
|
Definition
| children in whom large mesenteric nodes are seen at laporotomy/laporoscopy and who's appendix is normal |
|
|
Term
| define non specific abdominal pain? |
|
Definition
pain which resolves in 24-48hours
less severe than appendicitis with variable tenderness in RIF |
|
|
Term
intussussectipn
which is the most common site?
peak age of this occurring? |
|
Definition
common site is ileum going into ceacum at ileocecal valve
peak presentational age is between 3months and 2 years |
|
|
Term
| presentation of intussuseption? |
|
Definition
paroxysmal colicky pain with pallor, abdominal mass and red current jelly stool
shock is an important complication and requires treatment |
|
|
Term
|
Definition
reduction is attempted via air insufflation unless peritonitis is present
if this is unsuccessful or if peritonitis is present then surgery is required. |
|
|
Term
| what is a mockers diverticulum and remnant of? |
|
Definition
| the vitello intestinal duct |
|
|
Term
| what usually presents in the first 1-3 days of life with intestinal obstruction from Ladd bands? |
|
Definition
|
|
Term
| what ix would you do if a child presented with bilious vomiting? |
|
Definition
urgent upper GI contrast study.
if there are signs of vascular compromise then you would need to do an urgent laparotomy |
|
|
Term
| if a child has epigastric pain at night and heamatemesis what diagnosis are you thinking? |
|
Definition
|
|
Term
| what is the most frequent cause of gastroenteritis in developed countries? |
|
Definition
|
|
Term
| if there is blood in the still with diarrhoea what would you think the broad causative organism is? |
|
Definition
bacterial.
e.g campylobacter jejuni, shigella
with shigella there is usually accompanying high grade fever |
|
|
Term
|
Definition
it is used to diagnose post gastroenteritis syndrome where there is a temporary lactose intolerance following gastroenteritis.
the positive test shows non absorbed sugar in the stools. |
|
|
Term
| in children 1-3months cefotaxime and ampicillin is given if suspected sepsis, what does ampicillin cover against? |
|
Definition
|
|
Term
| which condition can cause subacute sclerosing pan encephalitis? |
|
Definition
|
|
Term
| how long should you rx for encephalitis with aciclovir in suspected or proven cases? |
|
Definition
|
|
Term
if a child has
fever >39 degrees
hypotension
diffuse erythematous macular rash
what are you thinking? |
|
Definition
|
|
Term
| mx of toxic shock syndrome? |
|
Definition
abx
3rd gen cephalosporin e.g. ceftriaxone with clindamycin
clindamycin acts on bacterial ribosomes to to switch off toxin production |
|
|
Term
|
Definition
where areas of epidermis separate on gentle pressure.
seen in scalded skin syndrome and SJS |
|
|
Term
| there are currentl 8 well known human herpes viruses what are they? |
|
Definition
HSV 1 and 2
varicella zoster
CMV
EBV
herpes virus 6,7 and 8
herpes 8 is associated with Kaposi sarcoma |
|
|
Term
|
Definition
| viral DNA polymerase inhibitor |
|
|
Term
a child has a rash and a week after he has cerebelitis with an ataxic gait. this resolves within a month
what is the causative organism of his rash and ataxic gait? |
|
Definition
|
|
Term
|
Definition
ganciclovir or
foscarnet
both have serious side effects |
|
|
Term
| what do HHV 6 and 7 commonly cause? |
|
Definition
Roseola infantum
high fever with malaise lasting a few days
when fever wanes a generalised macular rash appears
HHV6 and 7 are a common cause for febrile convulsions |
|
|
Term
| what are the complication of parvo virus? |
|
Definition
can cause aplastic crisis in haemolytic anemias e.g. sickle cell OR
hydrops in the fetus |
|
|
Term
| in which condition that can affect the coronary arteries do children get inflammation of their BCG vaccination site? |
|
Definition
kawasakis
the platelet count rises typically in the second week of illness.
there is prolonged fever |
|
|
Term
| how to diagnose kawasaki. what symptoms do you need? |
|
Definition
prolonged fever of >5 and 4 other features of
non purulent conjunctivitis
red mucus membranes: strawberry tongue, dry cracked lips
cervical lymphadenopathy
rash
red and oedematous palms and soles or peeling of fingers and toes |
|
|
Term
a child is found to have a deficiency in CD18 and CD11b
what does this mean
what will happen as a consequence? |
|
Definition
this means they have a deficiency in neutrophil surface adhesion molecules
this leads to the inability of neutrophils to migrate to sites of infection/inflammation |
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