2paeds Flashcards
normal pCO2 and meaning in asthma attack
pCO2 4.5 - 6.0 kPa is normal
A normal pCO2 in an acute asthma attack indicates it is life-threatening
A 9-month-old boy presents to the paediatric emergency department with a fever and dry cough for 2 days. He was born 2 weeks premature and has no other significant past medical history. His temperature is 38.6ºC, heart rate is 110 beats per minute and respiratory rate is 45 breaths per minute. On examination, you find tachypnoea, a wheeze on auscultation and nasal flaring. No rash is noted and no abnormalities have been noted upon ear and throat examination.
Normal values of vital signs for children under 1 year are below:
Heart rate 110-160 beats per minute
Respiratory rate 30-40 breaths per minute
Systolic blood pressure 70-90 mmHg
Rectal temperature 36.6°C-37.5°C
What treatment would be recommended for this patient?
Bronchiolitis does not require antibiotics, children requires supportive management only
Important for meLess important
This is most likely bronchiolitis as the child was born prematurely, has a low-grade fever and a wheeze on auscultation. Bacterial infections may produce greater systemic upset and worse readings on recording vitals signs. The fact that there is no rash means it is unlikely to be impetigo. A normal ear and throat examination mean it is unlikely to be an ear or throat infection.
There is little evidence to support the use of antibiotics as there is a low prevalence of bacterial infections in patients with bronchiolitis. Amoxicillin and co-amoxiclav are antibiotics and would have minimal effect on most cases as these target bacterial infections.
Palivizumab is a monoclonal antibody that is used as a prophylaxis treatment to prevent lower respiratory tract infections and would not be given in an acute setting.
Management is largely supportive to maintain adequate hydration and oxygenation as the majority of cases are viral. Respiratory syncytial virus is the most common causative organism in bronchiolitis.
Which one of the following best describes the typical distribution of atopic eczema in a 10-month-old child?
face and trunk
A father brings his 3-year-old son to the GP with an itchy rash that started this morning on his face and torso before spreading to his limbs. This is associated with fever and general malaise.
The boy is usually in good health and takes no regular medications. He goes to nursery and is reaching his developmental milestones. Unfortunately, his family has not engaged with the childhood vaccination programme.
On examination, pertinent findings are a temperature of 38.1ºC and a widespread macular rash with vesicular lesions on the face and torso. There are no mucosal lesions.
What is the likely diagnosis?
chickenpox
You are asked to see a baby on the post-natal ward 10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
As this baby is less than 24 hours old they are high risk for developing severe hyperbilirubinaemia and must have their serum bilirubin urgently (within 2 hours). As this baby is less than 24 hours old the use of a transcutaneous bilirubinometer is inappropriate. Phototherapy is a treatment option for jaundice, but a serum bilirubin should be measured in case it is beyond the threshold for exchange transfusion.
Patent ductus arteriosus - pulse
Patent ductus arteriosus - large volume, bounding, collapsing pulse
A three-hour-old baby born at 39+3 weeks in the Special Care Baby Unit is showing mildly increased work of breathing, with subcostal recessions and grunting. Their respiratory rate is 66/min without apnoeas, their heart rate is 147bpm and their axillary temperature is 36.7ºC. They are pink, with normal pre-post ductal saturations and no additional heart sounds. Fontanelles are normal. Their birth weight is normal.
Chest X-ray hyperinflation and a thin fluid line in the right horizontal fissure.
Given the likely diagnosis, what is the most significant risk factor?
c sec - transient tachypnoea of newborn
You are working in a busy emergency department. A worried mother brings her 3-year-old boy to see you. He has been crying excessively for the last 12 hours and has had bilious vomiting on multiple occasions. The boy passed one stool around 2 hours ago which contained small amounts of blood.
With the patients likely diagnosis what initial investigation would you do?
uss for meckels diverticulum
A 5-year-old boy presents with a 3-week history of a limp and progressively worsening hip pain. On examination, he has a reduced range of movement in the hip and stiffness. An X-ray shows widening of the joint space but no significant deformity of the femoral head. The child is otherwise well.
What is the most appropriate next step in management for this patient?
Perthes’ disease presenting under the age of 6 years has a good prognosis requiring only observation
A 3-year-old child is brought to the emergency department with severe breathing difficulties. They were diagnosed with croup and given oral dexamethasone by the GP earlier in the day. On examination, their oxygen saturations are 89% on room air and there is significant intercostal recession.
Which of the following emergency treatments should be given to this child?
oxygen and adrenaline nebs
mycoplasma pneumonia tx
A macrolide e.g. erythromicin should be used for children with pneumonia if mycoplasma is suspected
prader-willi
imprinting
A two-week-old child is brought to the emergency department by his parents. He was slow to establish on feeds but was discharged home three days following delivery. During the past 7 hours he has been vomiting and the vomit is largely bile stained. On examination, he has a soft, distended abdomen.
The combination of a distended abdomen and bilious vomiting is highly suggestive of intestinal malrotation and volvulus. An urgent upper GI contrast study and ultrasound is required.
ambiguous genitalia. likely cause
Congenital adrenal hyperplasia is the likely cause of ambiguous genitalia.
haemophilia a inheritance
X-linked recessive conditions - there is no male-to-male transmission. Affected males can only have unaffected sons and carrier daughters.
Non-bilious vomiting in first few weeks of life is consistent with pyloric stenosis - acid base
Hypochloremic hypokalemic metabolic alkalosis
