Paeds

Front 1

By what ages are the following red flags?

1. No social smile

2. Not sitting

3. No walking

Back 1

1. Should smile by 2 months

2. Should sit by 9 months

3. Should walk by 18 months

Front 2

Failure to thrive:

What is suspected if child admitted to hospital:

1. Still fails to gain weight

2. Gains weight

Back 2

1. ORGANIC cause

- Increased energy demand

(lung/heart/liver disease, thyroid, anaemia)

- Nutrient loss

(GORD, pyloric stenosis, malabsorption)

2. NON-ORGANIC cause

- Poverty

- Child neglect

Front 3

Average term infant weighs:

1. 2.3kg

2. 3.3kg

3. 4.3kg

Back 3

2. 3.3kg

Front 4

At what age does a child:

1. Start having milk

2. Start weaning

Back 4

1. Milk 4-6 months

2. Food at 6 months

Front 5

Give benefits of breast milk:

Back 5

- Better nutritionally

- Easier digestible

- Improves immunity

- Suckling/bonding

Front 6

Give 3 drawbacks to formula milk:

Back 6

- No suckling

- High antigen load

- Expensive

- No anti-infection properties

Front 7

A child presents with vomiting, diarrhoea and rash after starting on breast milk.

What could this be?

Back 7

Milk Allergy:

- Through mother's breast - advice mother to eat less cow milk products

-

Front 8

What formula milk is #1 for an infant with a Cow Milk Protein Allergy?

Back 8

#1 = Hydrolysed protein feed - (nutramigen)

- Protein broken down so less recognisable by immune system

- If severe #2 = amino acid feed

Front 9

A child begins to experience diarrhoea after a bout of gastroenteritis when starting on milk again.

What could be the cause?

Back 9

Secondary lactose intolerance post-GE

- Self-limiting

- Will naturally produce more lactase

Front 10

Which is not an indication for supplements in infants:

1. >6 months breast fed

2. Bottle fed if Ca <500ml

3. 1-4 years in selected children

Back 10

3. False - ALL children at 1-4 years

Front 11

Child presents with persistent diarrhoea on weaning initiation. His brother has asthma.

What could be cause?

Back 11

- Gastroenteritis?

- Coeliac?

Front 12

Which is not always pathological jaundice?

1. <24 hours old

2. Conjugated Bilirubin

3. Prolonged Neonatal Jaundice

Back 12

3. Prolonged Neonatal

- Can be unconjugated (physiological) in breast mik jaundice, hypothyroidism

Front 13

Give causes of unconjugated hyperbilirubinaemia in the newborn:

Back 13

- Breast milk

- Haemolytic anaemias

- Infection

- Gilbert's

Front 14

What is the treatment for unconjugated hyperbilirubinaemia in the newborn.

Back 14

Treatment = PHOTOTHERAPY

- (makes bilirubin water-soluble and is excreted)

Front 15

What is the biggest complication of unconjugated hyperbilirubinaemia in the newborn.

Back 15

KERNICTERUS

- Lipid soluble so enters BBB and destroys tissue

Front 16

A jaundiced infant begins to stop feeding and has a seizure.

What could this be?

What could happen if not treated?

Back 16

KERNICTERUS

- Accumulation of unconjugated bilirubin in brain = encephalopathy

- Long term may cause learning difficulties

Front 17

Prolonged neonatal jaundice is defined as jaundice:

1. >1 week

2. >2 weeks

3. >3 weeks

Back 17

2. >2 weeks

Front 18

3 week old presents with jaundice.

1. Is this prolonged neonatal jaundice

2. What needs to be excluded?

Back 18

1. Yes as >2 weeks

2. BILIARY ATRESIA

- Split bilirubin test

Front 19

4 week old presents with prolonged jaundice.

What are 2 important tests and why?

Back 19

1. SPLIT BILIRUBIN

- all conjugated = PATHOLOGICAL and require further investigation

2. STOOL COLOUR

- Biliary atresia must be excluded

- PALE stools and DARK urine

Front 20

Which would cause prolonged neonatal jaundice with conjugated bilirubin?

1. Hypothyroidism

2. Breast milk jaundice

3. Neonatal Hepatitis

Back 20

3. Neonatal Hepatitis

- Others = unconjugated

Front 21

Child presents with

- Ascites

- Clubbing

- Failure to thrive

- Splenomegaly

1. Diagnosis?

2. Most likely cause?

Back 21

1. Liver Disease

2. Infectious cause most likely

Front 22

What is the #1 suspicion for:

1. Projectile vomiting

2. Billious vomiting

3. Effortless vomiting

Back 22

Projectile = PYLORIC STENOSIS

Billious = INTESTINAL OBSTRUCTION (Intussusception #1)

Effortless = GORD

Front 23

What is important conservative management for vomiting in infants?

Back 23

FLUIDS

Prevents dehydration

Front 24

A child presents with projectile vomiting.

How will you check if this is caused by pyloric stenosis?

Back 24

TEST FEED

- Palpable olive tumour

- Gastric peristalsis

Front 25

A 3 month old child presents with green bilious vomiting, constipation and shock.

Which cause of intestinal obstruction could be considered?

Back 25

Intussusception

- Can cause shock

Front 26

Intussusception is when the intestine is blocked from turning in on itself.

What 2 ways can this be reduced?

Back 26

- Air enema (air injected)

- Laparoscopic manual reduction

Front 27

What cause of vomiting is only seen in newborns?

Back 27

ATRESIAS (narrowing due to incomplete development)

- Intestinal = billious vomit

- Oesophogeal = effortless vomit/GORD

Front 28

What is it important to exclude in a child presenting with GORD?

Back 28

Cow's Milk intolerance

Front 29

Infant presents with effortless vomiting as well as apnoea and wheeze?

What is most likely cause?

Back 29

GORD

- Has respiratory manifestations

- Also failure to thrive, not feeding

Front 30

What neurological condition is characterized by GORD as well as dystonic body jerks?

Back 30

Sandifer's Syndrome

Front 31

Which is not indicated in treating an acute presentation of GORD in an infant:

1. Feed thickeners

2. Change in feeding position

3. Exclusion diet

4. Antacids

5. Fundoplication

Back 31

5. Fundoplication

- Surgery only indicated if reccurent with complications e.g oesophagitis

Front 32

Chronic diarrhoea =

1. >4 stools for >2 weeks

2. > 4 stools for >3 weeks

3. >4 stools for >4 weeks

Back 32

3. >4 stools for >4 weeks

Front 33

What is the common disorder in 1-4 year olds that causes diarrhoea due to gut immaturity?

Back 33

Toddler's diarrhoea

- Self-limiting

Front 34

Which is an example of osmotic diarrhoea?

1. Infection

2. IBD

3. Coeliac Disease

Back 34

3. Coeliac

- All MALABSORPTION = OSMOTIC disorder

- Infection/IBD = secretory diarrhoea disorder

Front 35

Infant presents with diarrhoea after starting on solid food. What could be suspected?

Back 35

Coeliac Disease (gliadin/gluten intolerance)

- If after milk - consider cow milk protein allergy

Front 36

Infant presents with steatorrhoea. What is a common cause of this?

Back 36

Cystic Fibrosis

- Thickened lipase secretion = cant reach fat

Front 37

What is false about allergies in infants?

1. Spontaneously resolve

2. Food better in uncooked form

3. Greater risk of asthma

Back 37

2. False - food better in COOKED form

Front 38

Investigations for Coeliac disease:

1. Gold Standard

2. Serology findings

Back 38

1. DUODENAL BIOPSY

2. TTG, anti-gliadin, HLA DQ

Front 39

Infant presents during weaning phase with

- Diarrhoea

- Weight loss

- Failure to thrive

What could be suspected?

Back 39

Coeliac Disease

Front 40

A child with coeliac disease has a greater risk of _______.

Back 40

Small bowel lymphoma

Front 41

Which is not an indication for enteral tube feeding?

1. CF

2. IBD
3. Oesophageal abnormality

4. Mild GORD

5. Gastroparesis

Back 41

4. False - only in SEVERE GORD

Front 42

Enteral tubing:

What is a 'buried bumper'

Back 42

Complication involving migration of tube