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42 Cards in this Set
- Front
- Back
By what ages are the following red flags?
1. No social smile 2. Not sitting 3. No walking |
1. Should smile by 2 months 2. Should sit by 9 months 3. Should walk by 18 months |
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Failure to thrive: What is suspected if child admitted to hospital: 1. Still fails to gain weight 2. Gains weight |
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 |
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Average term infant weighs: 1. 2.3kg 2. 3.3kg 3. 4.3kg |
2. 3.3kg |
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At what age does a child: 1. Start having milk 2. Start weaning |
1. Milk 4-6 months 2. Food at 6 months |
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Give benefits of breast milk: |
- Better nutritionally - Easier digestible - Improves immunity - Suckling/bonding |
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Give 3 drawbacks to formula milk: |
- No suckling - High antigen load - Expensive - No anti-infection properties |
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A child presents with vomiting, diarrhoea and rash after starting on breast milk. What could this be? |
Milk Allergy: - Through mother's breast - advice mother to eat less cow milk products - |
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What formula milk is #1 for an infant with a Cow Milk Protein Allergy? |
#1 = Hydrolysed protein feed - (nutramigen) - Protein broken down so less recognisable by immune system - If severe #2 = amino acid feed |
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A child begins to experience diarrhoea after a bout of gastroenteritis when starting on milk again. What could be the cause? |
Secondary lactose intolerance post-GE - Self-limiting - Will naturally produce more lactase |
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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 |
3. False - ALL children at 1-4 years |
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Child presents with persistent diarrhoea on weaning initiation. His brother has asthma. What could be cause? |
- Gastroenteritis? - Coeliac? |
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Which is not always pathological jaundice? 1. <24 hours old 2. Conjugated Bilirubin 3. Prolonged Neonatal Jaundice |
3. Prolonged Neonatal - Can be unconjugated (physiological) in breast mik jaundice, hypothyroidism |
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Give causes of unconjugated hyperbilirubinaemia in the newborn: |
- Breast milk - Haemolytic anaemias - Infection - Gilbert's |
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What is the treatment for unconjugated hyperbilirubinaemia in the newborn. |
Treatment = PHOTOTHERAPY - (makes bilirubin water-soluble and is excreted) |
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What is the biggest complication of unconjugated hyperbilirubinaemia in the newborn. |
KERNICTERUS - Lipid soluble so enters BBB and destroys tissue |
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A jaundiced infant begins to stop feeding and has a seizure.
What could this be? What could happen if not treated? |
KERNICTERUS - Accumulation of unconjugated bilirubin in brain = encephalopathy - Long term may cause learning difficulties |
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Prolonged neonatal jaundice is defined as jaundice: 1. >1 week 2. >2 weeks 3. >3 weeks |
2. >2 weeks |
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3 week old presents with jaundice. 1. Is this prolonged neonatal jaundice 2. What needs to be excluded? |
1. Yes as >2 weeks 2. BILIARY ATRESIA - Split bilirubin test |
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4 week old presents with prolonged jaundice. What are 2 important tests and why? |
1. SPLIT BILIRUBIN - all conjugated = PATHOLOGICAL and require further investigation 2. STOOL COLOUR - Biliary atresia must be excluded - PALE stools and DARK urine |
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Which would cause prolonged neonatal jaundice with conjugated bilirubin? 1. Hypothyroidism 2. Breast milk jaundice 3. Neonatal Hepatitis |
3. Neonatal Hepatitis - Others = unconjugated |
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Child presents with - Ascites - Clubbing - Failure to thrive - Splenomegaly 1. Diagnosis? 2. Most likely cause? |
1. Liver Disease 2. Infectious cause most likely |
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What is the #1 suspicion for: 1. Projectile vomiting 2. Billious vomiting 3. Effortless vomiting |
Projectile = PYLORIC STENOSIS Billious = INTESTINAL OBSTRUCTION (Intussusception #1) Effortless = GORD |
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What is important conservative management for vomiting in infants? |
FLUIDS Prevents dehydration |
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A child presents with projectile vomiting. How will you check if this is caused by pyloric stenosis? |
TEST FEED - Palpable olive tumour - Gastric peristalsis |
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A 3 month old child presents with green bilious vomiting, constipation and shock. Which cause of intestinal obstruction could be considered? |
Intussusception - Can cause shock |
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Intussusception is when the intestine is blocked from turning in on itself. What 2 ways can this be reduced? |
- Air enema (air injected) - Laparoscopic manual reduction
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What cause of vomiting is only seen in newborns? |
ATRESIAS (narrowing due to incomplete development) - Intestinal = billious vomit - Oesophogeal = effortless vomit/GORD |
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What is it important to exclude in a child presenting with GORD? |
Cow's Milk intolerance |
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Infant presents with effortless vomiting as well as apnoea and wheeze? What is most likely cause? |
GORD - Has respiratory manifestations - Also failure to thrive, not feeding |
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What neurological condition is characterized by GORD as well as dystonic body jerks? |
Sandifer's Syndrome |
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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 |
5. Fundoplication - Surgery only indicated if reccurent with complications e.g oesophagitis |
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Chronic diarrhoea = 1. >4 stools for >2 weeks 2. > 4 stools for >3 weeks 3. >4 stools for >4 weeks |
3. >4 stools for >4 weeks |
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What is the common disorder in 1-4 year olds that causes diarrhoea due to gut immaturity? |
Toddler's diarrhoea - Self-limiting |
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Which is an example of osmotic diarrhoea? 1. Infection 2. IBD 3. Coeliac Disease |
3. Coeliac - All MALABSORPTION = OSMOTIC disorder - Infection/IBD = secretory diarrhoea disorder |
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Infant presents with diarrhoea after starting on solid food. What could be suspected? |
Coeliac Disease (gliadin/gluten intolerance) - If after milk - consider cow milk protein allergy |
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Infant presents with steatorrhoea. What is a common cause of this? |
Cystic Fibrosis - Thickened lipase secretion = cant reach fat |
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What is false about allergies in infants? 1. Spontaneously resolve 2. Food better in uncooked form 3. Greater risk of asthma |
2. False - food better in COOKED form |
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Investigations for Coeliac disease: 1. Gold Standard 2. Serology findings |
1. DUODENAL BIOPSY 2. TTG, anti-gliadin, HLA DQ |
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Infant presents during weaning phase with - Diarrhoea - Weight loss - Failure to thrive What could be suspected? |
Coeliac Disease |
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A child with coeliac disease has a greater risk of _______. |
Small bowel lymphoma |
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Which is not an indication for enteral tube feeding? 1. CF 2. IBD 4. Mild GORD 5. Gastroparesis |
4. False - only in SEVERE GORD |
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Enteral tubing: What is a 'buried bumper' |
Complication involving migration of tube |