What are the GASTROINTESTINAL causes of vomiting in the paediatric population? And what is the most common? (not a GI cause)
FAMINE HIP GAIT Food allergy Atresia Meconium ileus Intussception Necrotising enterocolitis Eosipnophillic oesophagitis Hirschbrungs Intestinal malrotation Pyloric stenosis GOR / GORD Appendicitis Imperforate anus Tracheo-oesophageal fistula But the most common cause is most likely GASTROENTERITIS (an infectious cause)
What are the causes of STRIDOR in kids?
- ABCDEFGH
- WITH FEVER
- Abscess (peritonsillar or retropharyngeal)
- Big tonsils (tonsillitis) OR bacterial tracheitis
- Croup
- Diptheria
- Epiglottitis
- WITHOUT FEVER
- Floppy airways (tracheomalacia, bronchomalacia)
- Gagging on foreign object
- Hypersensitivity / hamangioma
Causes of ingionoscrotal lumps in neonates
HILT
- Hydrocele, encysted in the groin
- Inguinal hernia
- Lymphadenitis with an abscess - rare
- Testis - undescended
Causes of cyanotic heart disease in children
1,2,3,4,5 T’s
- 1 vessels - Truncus arteriosus
- 2 vessels swap - Transposition of the great arteries
- 3 = TRIcuspid atresia
- 4 = TETRAlogy of fallot
- 5 words = Total anomalous Pulmonary venous return
Causes of acyanotic L to right shunts in children
The three Ds
- vsD
- asD
- pDa
Causes of Petechaiae in a child
SHIELD
- Sepsis (meningococcal)
- Henoch-schonlein Purpura/Haemolytic uraemic syndrome
- Idiopathic Thrombocytopenic Purpura
- Events (non-accidental or accidental)
- Leukaemia
- Disseminated intravascular coagulation (usually in the context of severe illness)
Causes of Limp in all ages (including the unexpected Masquerades!)
MINIVAN
- Malignancy
- Leukaemia, solid tumour infiltration and osteosarcoma
- Infection
- Transient synovitis, septic arthritis, osteomyelitis
- Non-accidental injury and other trauma
- Inguinoscrotal pathology
- ??testicular torsion
- Vasculitis (HSP) and other rheumatic conditions
- Abdominal pathology
- Appendicitis and psoas involvement
- Neuromuscular disease
- Cerebral palsy and muscular dystrophy
Relative contraindications to IOL
CAMP HI
- C section previously
- Act quickly (code green)
- Malpresentation
- Placenta Previa
- High parity - increased risk of uterine rupture
- Infections / IUGR
Risks of IOL
PATH and ROAD
- Prolapsed umbilical cord
- Abruption of placenta
- Tachysystole/ Hyperstimulation
- Hyponatraemia and Haemorrhage
- Rupture of uterus
- Oedema/fluid retention
- Atonic uterus
- Didn’t work -> failure of induction
Requirements for a forceps delivery
FORCEPS
- Fully dilated cervix
- OA poition (ideal)
- Ruptured membrances
- Contractions/catheter
- Episotomy and epidural
- Presentation: cephalic
- Spines - at or below
Methods of IOL
PROMPT
- Prostaglandins
- Rupture of membranes
- Oxytocin
- Membrane stretch and sweep
- Put in a
- Transcervical catheter
Reading a CTG
DR C BRaVADO
- Define risks
- Contractions
- Baseline Rate
- Variability
- Accelerations
- Decelerations
- Overall Impression
Foetal monitoring
SAM BLACK
- Clinical
- Symphsiofundal height
- Auscultate the foetal heart
- Movements felt
- Sonographic
- Biophysical profile
- Lengths - HC, AC, FL and estimated weight
- Amniotic Fluid index
- CTG
- Kink in diastole? Uterine artery dopler
Causes of limp/non-weight bearing in a child?
Hop to Move ADAPTATIONS
- HSP
- Malignancy (ALL)
- Articular or non-articular stress fracture
- DDH (age 1-4)
- Arthritis/JIA
- Perthes disease (age 4-10)
- Toddler’s fracture (age 1-4)
- Apendicitis
- Transient synovitis
- Inguinoscrotal pathology/testicular torsion
- Osteomyelitis/septic arthritis
- NAI
- SUFE (aged>10)
Asthma history
FIT CAMPSITES
- Frequency and severity of attacks
- Interval symptoms
- Technique using inhaler
- Compliance with preventer
- Atopy, personal or family history of
- Medications, past and current
- Pets in the house
- School missed
- ICU or hospital admissions
- Triggers
- Exercise tolerance
- Smokers in the house
What is the criteria for diagnosis of anorexia nervosa?
Weight **F**ear **B**others **A**norexics
Weight criterion: failure to maintain weight ti be >85% of the expected weight for age, or less than BMI 17.5
Fear: the intense fear of gaining weight despite being underweight.
Body Image: disturbance of perception of one’s body shape and weight, or unable to appreciate seriousness of the current low weight.
Amenorrhea: Needs to miss three consecutive menstrual cycles (enquire about OCP – could be OCP-induced)
What questions should you ask someone that you suspect to have bulimia nervosa?
SCOFF
- Do you make yourself SICK because you feel uncomfortably full?
- Do you worry you have lost CONTROL over how much you eat?
- Have you recently lost more than ONE stone (6.35kg) in a three month period?
- Do you believe youself to be FAT when others say you are too thin?
- Would you say your FOOD dominates your life?
