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259 Cards in this Set
- Front
- Back
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T/F Most children outgrow regurgitation by 1 year of age
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True
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Rx of reflux (evidence based)
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no Rx required for most children
thickened feeds PPI for suspected esophagitis fundoplication if severe |
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Most common cause of lactose intolerance?
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primary lactase deficiency
uncommon < 2 years of age |
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What is frothy stools in a breastfed infant due to?
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relative lactose malabsorption
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What weight is allowable to lose in newborn?
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10% of birthweight
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How much weight gain is expected per week in newborn?
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100-200 g/week
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What drug can be given to improve breast milk supply?
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Motilium (domperidone) - dopamine antagonist
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What is the definition of constipation in a newborn?
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delay or difficulty passing stool present for >2 weeks
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What is the most common cause of constipation in a child?
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functional constipation
aka withholding stool to avoid unpleasant defacation |
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What is Herschsbrung's disease?
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failure of normal innervation of the distal colon by the ganglion cells of the myenteric plexus
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Signs of Herschsprung's disease
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failure of passage of meconium
toxic megacolon |
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Rx of Herschsprung's disease
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colostomy of aganglionic bowel
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What is craniosynostosis?
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premature fusion of one or more cranial sutures
(palpable ridging over fused suture, compensatory overgrowth of other sutures) |
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What percentage of ARIs are viral in kids?
What are the common pathogens? |
90%
Rhinovirus RSV Parainfluenzae 1, 2, 3 Influenza Adenovirus |
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Most common cause of bronchiolitis
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RSV
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Rx of bronchiolitis
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supportive - oxygen if low sats
bronchodilator not effective, but hard to distinguish patients who are asthmatic |
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When is bronchiolitis most common?
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< 1 years, most common between 2 weeks and 9 months
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What causes 75% of Croup cases?
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Parainfluenza 1, 2, 3
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When is the peak incidence of croup?
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2nd year of life
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Rx for Croup
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mild: prednisilone or dexamethsone
if severe, adrenaline and dexamethasone |
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Cause of epiglottitis
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HiB
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Signs of epiglottitis
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cherry red swollen epiglottis
drooling minimal cough |
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Rx of epiglottitis
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Manage airway
Antibiotics - ceftriaxone |
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What is the most common cause of anaphylaxis in children?
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peanuts
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T/F Most children do not outgrow their food allergies
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True
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T/F IgE sensitisation correlates with clinical atopy
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False
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T/F RAST tests are superior to skin prick testing for diagnosis of IgE sensitisation
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False
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What is the most significant risk factor for allergies in children?
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family history
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Do skin prick tests have negative and positive predictive values?
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over 2 years, good negative predictive value
fair positive predictive value when combined with history |
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Does size of reaction in skin tests correlate with severity of reaction in atopy
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No
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What percentage of allergies present in the first year of life?
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80%
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Contraindications to skin prick testing?
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severe eczema
have taken anti-histamine (can still do RAST if taken anti-histamine) |
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Length of time of IgE mediated reaction
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< 2 hours
if 2-4 hours, think non-IgE mediated food allergy |
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Effect of burns on circulation
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local --> edema
general --> hypovolemia |
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Effect of burns on metabolism
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anabolic hormones decreased: growth hormone, thyroxine, anabolic steroids
catabolic hormones increased: glucagon, cortisol, catecholamines |
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What is the zone necrosis?
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central area of the burn
does not become viable ever again |
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What is zone of stasis?
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progressive necrosis if not resuscitated within 26-48 hours
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What is zone of hyperemia?
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outermost area of burn
will always be viable |
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First aid for burns
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ABC
run under cool water for 30 minutes do not use ice |
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What is the rule of 9s for burns in children?
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Head: 18%
Body: 18% front, 18% back Arms: 9% each Legs: 14% each One hand: 1% |
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Difference between superficial and deep thickness burns
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Superficial: red, painful
partial thickness superficial: painful partial thickness deep: painless, full thickness: painless, white, charred |
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Rx of full thickness burns
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wound contraction or skin grafting
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Formula for fluid resus in paeds for burns (1st 24 hours)
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3-4 ml X % BSA affected X wt in kg
run first 1/2 in 1st 8 hours, 2nd 1/2 over 16 hours Hartmann's solution |
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Rx for inhalation burns
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give oxygen, maybe hyperbaric if severe
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Criteria for outpatient treatment
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2-5%: outpatient
on trunk or limbs, not over joints, not circumferential |
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Safe transport to burns unit
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<6 hours, clean burn: saline + plastic wrap
>6 hours, dirty burn: chlorhex + acticoat |
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Features of lung abscess on xray
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air-fluid levels
round density opaque rim |
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What bacteria causes lung abscesses?
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Anaerobic bacteria
occasionally staph aureus and klebsiella |
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Treatment of lung abscess
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antibiotics
ampicillin + beta lactamase inhibitor (augmentin) |
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Biomechanical differences in bone between adults and paeds
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1. ligaments are stronger than growth plate --> epiphyseal separation, less likely for sprains/dislocations
2. young bone more porous --> most plastic/deformation |
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What is a buckle fracture? What is a greenstick fracture?
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Buckle: has a fracture on one side and bend on the other
Greenstick: no fracture on one side and bend on the other |
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When do you not expect remodelling in bone?
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1. intra-articular fractures
2. diaphysis fractures w gross angulation, shortening, rotation 3. fractures w/ deformity at right angles to plane of joint mvmt |
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T/F Speed of healing is slower in children
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False
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Tell me about Salter Harris fractures
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S: straight - thru physis (growth plate)
A: above - metaphysis AND growth plate L: low - thru epiphysis and growth plate T: thru and thru - thru epihysis AND metaphysis R: ram - crush |
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What special extra xrays do you need in kids?
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joint above and below
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How soon after injury do you need to perform surgery in an open fracture in kids?
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w/in 6 hours
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Clinical presentation of pulled elbow
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aka subluxation of radial head
refusal to use arm pronated forearm pain with supination passive ROM normal |
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Treatment of pulled elbow
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flex and supinate
if doesn't get better, reconsider dx rest if unsuccessful |
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What does fat pad sign indicate?
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in trauma, marker of fracture
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Up until what age is having a >38 degree temperature a red flag (requires admission to hospital)?
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up to 3 months
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What are clinical features of intussception?
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abdo pain - knees up to chest
episodic abdo pain - 2-3x per day red currant jelly stool vomiting - predominant feature sausage shaped mass diarrhoea is quite common |
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At what age does intussception present?
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6-18 months
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What signs are seen on imaging for intussception?
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target sign - telescoping
crescent sign - crescent lucency in left upper quadrant w soft tissue mass |
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Management of intussception
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1. NG tube
2. ABs 3. air enema |
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What is seen on ultrasound in pyloric stenosis
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thickened elongated pylorus
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What are the electrolytes in pyloric stenosis
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hypokalemia
hypochloremia alkalosis |
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Risk factors for pyloric stenosis
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male
maternal family history |
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Signs of pyloric stenosis
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presents 2-4 weeks
bilious projectile vomiting olive sign constipation dehydration |
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Management of pyloric stenosis
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Ramstedt pyloromyotomy
not urgent, do surgery after electrolyte balance |
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At what age do babies smile?
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6 weeks
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incubation period for pertussis
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10-14 days
symptoms show after 2-3 days of coryza |
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What is the bacteria that causes pertussis?
gram negative, gram positive |
bordetella pertussis, gram neg
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T/F pediatric cancers are sensitive to chemotherapy
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true
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What is the commonest childhood malignancy?
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ALL
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Lab features of ALL and AML
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anemia (Hb 50-60)
thrombocytopenia neutropenia +/- circulating blasts |
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What age is a poor prognosis in ALL
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<12 months
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Good prognostic factors in ALL
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age 2 - 10
lower WCC prednisone response no CNS disease hyperdiploidy B-precursor t (12;21) |
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Why is leukocytosis bad in AML
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high viscosity --> high risk of intracranial bleeding
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What site is the most common solid tumor in kids?
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brain
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Where are brain tumors more likely to develop in kids?
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posterior fossa
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What is a neuroblastoma?
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tumors of adrenal gland or of sympathetic trunks deriving from primitive neural crest cells
most are abdominal in adrenal gland or sympathetic chain poor prognosis, most present with metastatic disease |
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What gene is associated with neuroblastoma?
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N-MYC oncogene
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Classic presentation of neuroblastoma
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pale, irritable
reluctant to walk (bony mets) periorbital ecchymoses |
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What investigation assists in dx neuroblastoma
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urinary catecholamines
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What is a Wilm's tumor?
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nephroblastoma
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What are the clinical features of a Wilm's tumor?
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80% asymptomatic, unilateral painless abdominal mass
hematuria mets to lung and liver |
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Management of Wilm's tumor
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nephrectomy
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Which virus is associated with Hodgkin's lymphoma
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EBV
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What is the mainstay treatment for Hodgkin's lymphoma?
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chemotherapy
also can do radiotherapy |
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What is a common cause of intussception
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lymphoma
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What is elevated in tumor lysis syndrome
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LDH
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Which cell is involved in Burkitt's lymphoma - B or T
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B
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What is Ewing's sarcoma?
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bone tumor that affects diaphysis and axial skeleton
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Which chromosomal translocation is involved in Ewing's sarcoma?
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11;22
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How does Ewing's sarcoma present?
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pathological fracture
met disease |
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Xray of Ewing's sarcoma
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moth-eaten pattern often accompanied by onion-skin periosteal reaction
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When do bone sarcomas usually present?
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teenagers, during growth spurt
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Where does osteosarcomas present?
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growing end of long bones
most common distal femur, proximal tibia and proximal humerus |
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What is the most common soft tissue sarcoma? Where does it usually occur?
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rhabdomyosarcoma, genitourinary
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How does rhabdomyosarcoma usually present?
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firm, painless mass
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What are the complications of measles?
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* encephalitis: typically occurs 1-2 weeks following the onset of the illness)
* subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness * febrile convulsions * pneumonia, tracheitis * keratoconjunctivitis, corneal ulceration * diarrhoea * increased incidence of appendicitis * myocarditis |
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How many primary teeth do humans have? How many permanent?
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20, 32
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When do primary teeth erupt? When are primary teeth completely erupted?
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6 months, 2 years old
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Rx of mild acute asthma attack
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mild = >60% PEF, wheeze
6 (<20 kg) or 12 (>20kg) puffs of salbutamol if it's been going on for a few days - oral prednisolone |
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Rx of moderate acute asthma attack
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mod = PEF 40-60%, O2 92-95%
6 or 12 puffs of salbutamol every 20 minutes for 1 hr oral pred for 3 days |
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Rx for severe acute asthma attack
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severe = PEF <40%, unable to speak, O2 <92%
6 or 12 puffs of salbutamol, every 20 minutes for 1 hr iptratropium oral pred |
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Rx of critical acute asthma attack
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nebulized salbutamol
nebulized ipratropium IV methylpred magnesium sulphate aminophylline - if very sick |
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When do you do chest xray in asthma attack?
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mild-mod: only if focal signs present
severe: only if no response to initial therapy or pneumothorax |
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when can you discharge asthma pts in regards to salbutamol timing?
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if taking salbutamol every 3 hourly or less, they can go home
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What is infrequent intermittent asthma? How do you Rx?
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exacerbation every 4-6 weeks
Rx w salbutamol |
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What is frequent intermittent asthma?
How do you treat? |
exacerbation 2x / month
Rx w salbutamol, then add montelukast, sodium cromoglycate, or nedocromyl sodium if no effective, give inhaled CS |
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What is persistent asthma? How do you treat?
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>2 exacerbations/month
Rx with salbutamol, inhaled CS, then add LABA |
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6 step asthma management plan
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1. assess severity
2. achieve best lung fxn 3. maintain best lung fxn - triggers 4. " - meds 5. make a management plan 6. educate and review |
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At what age can you use a puffer?
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> 6 years old
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What is the asthma first aid plan?
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1. give 4 puffs of reliever, 4 breaths in between
2. wait 4 minutes 3. repeat 4. if no improvement, call ambo |
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What PEF is considered life threatening in asthma?
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<33%
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Difference between measles and roseola infantum
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measles: unwell, fever and rash together, confluent lesions
roseola: child is well, fever falls with rash, rash mainly on trunk, discrete lesions |
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When are children with varicella infectious?
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48 hours before rash until lesions crust (usually 3-7 days after rash shows up)
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Where is the varicella rash predominantly?
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truncal
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Most common complication of varicella?
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superinfection with GAS and staph aureus
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What type of vaccine is varicella?
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live attenuated, wildtype strain
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Rx of varicella in kids
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supportive, pain relief
only if immunocompromised, give acyclovir |
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How does shingles usually present in the immunocompromised child?
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disseminated disease - pneumonitis, hepatitis, brain
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Which virus seen in childhood affects the gumlines?
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Herpes simplex virus
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What is the commonest cause of hand, foot and mouth disease?
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Coxsackie 16
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Which enterovirus is associated with most severe hand, foot and mouth disease?
|
enterovirus 71
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What is impetigo?
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bacterial skin infection, typically on face, can get on top of insect bites/abrasions, most common organism is staph aureus, not painful, very contagious, rx w topical chlorhexidene +/- ABs
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Complications of measles
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at time: otitis media, sinusitis, bronchopneumonia, croup, encephalitis, myocarditis
later: subacute sclerosing panencephalitis |
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Rx of measles
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supportive
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How is rubella rash different from measles?
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measles = peeling
rubella = develops more quickly, disappears more quickly |
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Features of Scarlet fever
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4Ss: sore throat, strawberry tongue, sandpaper rash, perioral sparing
3Ps: non pruritic, non painful, peeling |
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What is scarlet fever caused by?
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GAS
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What are the complications of scarlet fever?
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GN and rheumatic fever
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What is Kawasaki disease?
|
acute febrile vasculitis of childhood common in Asians
1-8 years old Fever for 5 days + 4/5 criteria 1. bilateral conjuctival injection 2. oral changes - red mouth, cracked lips 3. swelling of hands and feet 4. cervical lymphadenopathy 5. rash |
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Complications of Kawasaki disease
|
vasculitic complications: myocarditis, thrombi
BIG risk of coronary artery aneurysms - urgent treatment as soon as they present to avoid getting them |
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Investigations in Kawasaki disease
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echo
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Rx for Kawasaki disease
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aspirin (6-8 weeks) and Ig
screen for coronary artery disease |
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Clinical features of Parvovirus B19 (erythema infectiosum)
|
slapped cheek, 1-2 weeks later lacy maculopapular rash on arms and legs
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What causes erythema infectiosum
|
Parvovirus B19
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Clinical features of meningococcal infection
|
petechial, or purpuric non blanching rash
two major clinical presentations: meningitis or septicemia fever, vomiting, headache, neck stiffness |
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Rx of meningococcal disease
|
Im penicillin in GP's office
at hospital, 3rd generation cephalosporin |
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What is gower's manoeuvre?
|
indicates weakness of proximal mm
patient must use his hands and arms to "walk" up his own body from a sitting position due to lack of hip and thigh mm strength |
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What is spinal muscular atrophy?
|
Degeneration of the anterior horn cells in the spinal cord and motor nuclei in the brainstem
4 types autosomal recessive |
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What is spinal muscular atrophy type 1?
|
Most common and severe type
Most infants die before one year of age due to respirator failure Marked proximal weakness Decreased movement Bell shpaed chest Tongue fasciculations absent reflexes |
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What is spinal muscular atrophy type 2?
|
Presents later in life
Do gain ability to sit but can't stand unsupported |
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Charcot marie tooth?
|
DISTAL MM weakness
Hereditary Mutation in myelin gene --> defects in myelin structure, and formation Features: motor and sensory nerve problems, distal leg weakness, foot deformities (pez cavus, hammer toes) Early complaints - sprained ankles |
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What do the nerve conduction studies show in Carcot marie tooth?
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Severe slowing of conduction in both motor and sensory < 60%
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Are nerve conduction studies /electromyography normal or abnormal in spinal muscular atrophy?
|
Nerve conduction studies are normal
Electromyography is abnormal |
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T/F Adolescents require less sleep than kids
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True
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T/F Adolescents have a tendency to fall asleep and wake later in the day
|
True
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T/F Adolescents have marked reduction in slow wave sleep
|
True - less restorative sleep
|
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What is the most common sleep problem in adolescence?
|
poor sleep hygiene
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What type of genetic mutation is muscular dystrophy?
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X-linked recessive
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Genetic pattern in muscular dystrophy
|
1/3 spontaneous mutations
rest are x-linked recessive |
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Pathophysiology of muscular dystrophy
|
missing dystrophin --> mm fibers become fragile and breakdown
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Clinical features of muscular dystrophy
|
proxial mm weakness by age 3
decreased reflexes hypertrophy of calf mm wasting of thigh mm delayed motor and cognitive development cardiomyopathy respiratory insufficiency die between 20-30 |
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Treatment of muscular dystrophy
|
supportive
corticosteroids |
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What is difference between Duchenne and Becker muscular dystrophy
|
X-linked defect in dystrophin gene
Becker = defect is not complete, similar to Duchenne but onset is later and progression is slower |
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Classic red flag of purpuric rash and bulging fontanelle means...
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meningitis
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Classic red flag of high pitched scream means...
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increased ICP/child abuse
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Classic red flag of biphasic stridor means...
|
complete airway obstruction
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Classic red flag of bile stained vomiting means...
|
bowel obstruction
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Difference between decorticate and decerebrate posturing
|
decorticate (flexion): suggests lesion above the brainstem
decerebrate (extension): suggests lesion below the brainstem |
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What is a very effective measure of circulation on physical exam?
|
capillary refill
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What is the number of nappies in reduced urine output?
|
<4 in 24 hours
|
|
|
Most common cause of gastroenteritis
|
rotavirus
2nd most common: astrovirus 3rd: norwalk |
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At what % dehdyration do you get tachycardia? dry mucous membranes?
|
5%
|
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At what % dehydration do you get sunken eyes and fontanelle, reduced skin turgor?
|
7-9%
|
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T/F Capillary refill has been shown to correlate with degree of dehydration
|
True
|
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Is rice oral rehydration better than standard rehydration?
|
no, there is no difference
|
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Which is the recommended rehydration solution? oral or iv?
|
oral
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What is the rehydration formula and when do you give it?
|
5 x 10 x wt in kg --> over 24 hours
given when 5% dehydrated |
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In fluids, what is the bolus dose and when do you give it?
|
10-20 mL/kg
given when >10% dehydration |
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Which fluids do you give for maintenance, rehydration, bolus?
|
bolus = Hartmann's or normal saline
the rest are N/2 NEVER give N/4! |
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How much potassium do you give in rehydration?
|
3 mmol/kg/24hrs
|
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What fluid do you use in hypernatremic dehydration?
|
N/2 + 2.5% dextrose
|
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What is the most common organism in otitis externa?
|
fungal
bacterial: pseudomonas or staph |
|
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Treatment of otitis externa
|
sofradex, ciprooxin
|
|
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What is the ductus venosus?
|
connection between umbilical vein and IVC
|
|
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What takes oxygenated blood from the placenta to the baby? vein or artery?
|
vein - 1
|
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Which fetal shunt closes first after birth? Why?
|
PFO
Increase in LA pressure secondary to increase in pulmonary blood flow and pulmonary venous return |
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At what day does PDA start to close? completely close? why?
|
Starts closing within 10-15 hours
Closes permanently within 2-3 weeks Why? increase in PaO2, decreased prostaglandin |
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When does ductus venosus start to close? why?
|
Right after birth
takes 3-7 days why? Probably passive due to reduced flow and pressure |
|
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Which ventricle is dominant in neonates?
|
RV
This dominance slowly diminshes through childhood |
|
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Most common congenital heart disease?
|
VSD
|
|
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Features of an innocent murmur?
|
systolic
ejection musical grade 1-3 (no palpable thrill) changes with body position varies with review (augmented by illness) |
|
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What feature will be found on a normal newborn ECG?
|
RAD
|
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What is the most common cyanotic heart defect?
|
tetraology of fallot
|
|
|
What are the 4 features of tetralogy of fallot?
|
RVH
Overiding position of aorta VSD RVOTO - pulmonary stenosis |
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What determines severity of Tetralogy of Fallot?
|
right ventricular outflow stenosis
|
|
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Management of Tetralogy of Fallot
|
surgery within 2 years of life
|
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Murmur heard in Tetralogy of Fallot
|
harsh ejection systolic
|
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Murmur heard in VSD
|
systolic at left sternal base
|
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Murmur heard in ASD
|
ejection systolic murmur
|
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|
female:male ratio in DDH
|
6:1
|
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Imaging for DDH
|
<6 months U/S
>6 months xray |
|
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Rx for DDH
|
<6 months: closed reduction, put in brace, frog leg
6-12 months: try closed, if no success --> open >12 months: open reduction, brace >18 months: acetabuloplasty |
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Irritable hip DDx based on age
|
2-5 years: transient synovitis
4-10 years: Perthe's 10-15 years: Slipped capital femoral epiphysis |
|
|
Presentation of Perthe's disease
|
limp
+ Trendelenberg sign limited hip abduction |
|
|
What is the bad outcome of Perthe's disease and slipped femoral epiphysis?
|
> 50 % get Osteoarthritis by age 40 (50 for slipped epiphysis)
|
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Rx of slipped capital epiphysis
|
surgical emergency!
|
|
|
Most common form of juvenile idiopathic arthritis
|
oligarthritis </=4 joints (50%)
>5 joint (30%) |
|
|
What is the commonest vasculitis in childhood?
|
HSP
peak incidence: 4-10 years |
|
|
What size vessels does HSP affect?
|
small
|
|
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Criteria for HSP
|
must have 2/4:
1. palpable purpura 2. <20 years 3. bowel angina 4. granulocytes in walls of arterioles or venules w/ biopsy |
|
|
DO you want a higher or a lower uring output in kids cf adults
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higher urine output
Toddlers - 1.5ml/kg/hr < 1 year 2ml/kd/hr |
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Rx of HSP
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NSAIDs
severe abdo pain may warrant steroids recurrence risk is 30% |
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Heart rate values in pediatric patients
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up to 1 year: 100-170
slowly goes to adult values at age 12 |
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RR values in pediatric patients
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Maximums
newborn: 60 1 yr: 40 2 yr: 30 5 yr: 20 |
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BP systolic values in pediatric patients
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newborn: 50
1 yr: 90 2 yr: 100 5 yr: 110 >12 yrs: 120 |
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What is impetigo?
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skin disorder caused Staph aureus and GAS --> blister with vesicle/pustule, usually<2 cm, with honey colored plaque/crust
mimics tinea |
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Rx of impetigo
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swab with chlorhex
oral ABs for 7-10 days |
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What causes dermatophyte folliculitis? Rx?
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fungus
Rx w gruseifulvin topical ABs won't work! |
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What is tinea caused by? What does it look like?
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dermatophytes - fungi
annular, central clearing rash like, pruritic on skin, hair, nails |
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Difference between eczema and tinea
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tinea is unilateral
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Rx of tinea
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anti-fungals for 6 weeks, griseofulvin
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What is molluscum contagiosum caused by?
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pox virus
acquired thru direct contact - pools, tubs, family bath tub |
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Which eye reflex is the first to be developed? When does it appear
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Following reflex
first week of life |
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Which eye infections are common 0-2 months?
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Opthalmia neonatorum
leukocorya retinopathy of prematurity wandering eyes |
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Which infections are common 3months - 3y
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watery eye - nasolacrimal duct, congenital glaucoma
Red eyes and lids - conjunctivities, cellulitis Leukocorya Strabismus Injury |
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What is epiphora?
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watery eyes
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What is congenital nasolacrimal duct obstruction?
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mucocele of the lacrimal sac
presents with epiphora and d/c |
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What are causes of a watery eye (epiphora)
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nasolacrimal duct obstruction
congenital glaucoma corneal irritation from foreign body or lashes |
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Management of NL duct obstruction?
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massage over lacrimal sac
bathe with saline probe and irrigate if not resolved by 1 year |
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What are the most common causes of neonatal conjunctivitis?
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Onset day 1 gonoccoal
Staph 4-5 days of life Onset day 10 - chlamydia |
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How does neonatal conjunctivitis present?
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swollen red eyes and eyelids
Mucopurulent dc |
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When are the peri-auricular lymph nodes enlarged in neonatal conjunctivits?
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viral
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DO you use steroid eye drops in herpes simplex keratitis?
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NO you can get corneal scarring
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What do you see in herpes simplex keratitis with fluorescein?
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dendritic ulcer
looks like branching tree |
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Treatment of strabismus?
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Cover good eye
Kick that bad eye into gear |
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What is strabismus?
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Misalignment of the eyes, squint
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What is amblyopia?
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lazy eye
= unilateral strabismus |
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What is leukocoria?
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white pupil
|
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What are the 2 causes of leukocoria?
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retinoblastoma
congenital cataract |
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What is retinoblatoma?
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intraocular malignancy - cancer of retina (therefore no red reflex)
sporadic or genetic associated with chromosome 13 bilateral in 25% |
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How might a retinoblastoma present?
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leukocoria
strabsmus secondary glaucoma uveitis |
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How do you manage congenital cataract?
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aphakic spectacles
contact lens correction can do surgery if bilateral and complete |
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How do you tell the difference between orbital and preseptal cellulitis?
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if eye is pushed forward it is orbital i.e. proptosis
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Do you admit a child with preseptal or orbital cellulitis?
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YES
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What are small cysts on the eyelid of a child and how do you treat them?
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Meibomina glands - acute infection
treat with heat, topical/systemic antibiotics, incise and curette under GA |
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At what age do children walk, sit unsupported, babble?
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Walk - 18 months
Sit unsupported 9 months babble - 6 months |
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what gives you a machinery murmour?
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PDA
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How do you treat a strawberry naevus?
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= large red thing on face
leave it alone, it will go away by itself, the only time you take it off is if it's obstructing something like vision |
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What is a machinery murmur associated with?
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PDA
|
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Incidence of VUR
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up to 20%
70% of kids with UTI have VUR |
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Ix in UTI
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> 6 months and typical: no imaging, AB prophlyaxis not indicated in first
> 6 months and recurrent: U/S w/in 6 weeks, consider DMSA scan <6 months: do U/S within 6 weeks <6 months and recurrent: U/S during infection and follow up with screening |
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What is a DTPA scan?
|
functional scan - shows blood flow and obstruction
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What is a DMSA?
|
demonstrates scarring in the kidneys
done 4-6 months after infection in atypical or recurrent UTI |
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What is MCUG?
|
detects VUR
shows anatomical detail of bladder and urethra done if family hx, dilatation on U/S, poor urine flow, non E Coli |
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Rx for UTI
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if young (1-6 months) and unwell: gent + benpen (or ampicillin)
if well: oral bactrim or cephalexin |
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What is not likely to be minimal change disease in nephrotic syndrome?
|
1. renal impairment
2. significant HTN 3. age <1 year >10 years 4. macroscopic or persistent microscopic hematuria 5. red cell casts in the urine 6. family hx of nephrotic syndrome 7. syndromic child 8. steroid resistance |
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T/F Cow's milk is a good source of iron
|
false, it has none!
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Commonest cause of chronic neutropenia
|
autoimmune neutropenia of infancy
|
|
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Rx of AI neutropenia infancy
|
benign, will get better by 4 yo
give ABs if infection |
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Blood test AML
|
high WCC and differentials
low Hb and platelets |
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Rx of AML
|
chemo
fluids to combat viscosity platelets so no hemorrhage |
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Blood film in G6PD deficiency
|
low Hb,
high retics high WCC, neutrophils high total bilirubin (due to hemolysis) blood film: bite and blister cells |
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is G6PD deficiency x-linked? recessive or dominant?
|
X- linked autosomal recessive
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What are blood tests in ALL
|
pancytopenia
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