Acutely Ill Child Flashcards
1
Q
What is bronchiolitis?
A
Acute viral inflammatory injury of the bronchioles
2
Q
What causes bronchiolitis and when does it occur?
A
- Viral, most commonly due to respiratory syncytial virus (RSV)
- Generally occurs in children under 1 year, most common in children under 6 months → occur in first and second winter of life
3
Q
What is the typical presentation for bronchiolitis?
A
- Viral URTI symptoms → running or snotty nose, sneezing, mucus in throat and watery eyes
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever (under 39 C)
- Apnoeas
- Signs of respiratory distress
- Wheeze and crackles on auscultation
4
Q
What is the management of bronchiolitis in children?
A
- Supportive
- oxygen
- fluid therapy
- feeding
5
Q
What is croup?
A
Upper respiratory tract infection causing oedema in the larynx
6
Q
What causes croup?
A
- Viral
- Classically parainfluenza virus
- Other common causes include influenza, adenovirus and RSV
- Used to be caused by diphtheria but this is now rare in developed countries due to vaccines.
7
Q
What is the typical presentation of croup?
A
- Increased work of breathing
- ‘Barking’cough, occurring in clusters of coughing episodes
- Hoarse voice
- Stridor
- Low gradefever
8
Q
What is the management of croup?
A
- Mild croup is largely self-limiting, but treatment with a single dose of a corticosteroid (e.g. dexamethasone) by mouth may be of benefit
- In moderate-severe croup requiring hospital admission:
- Oraldexamethasone - if too unwell to receive oral medication can give IM dexamethasone or nebulisedbudesonide
- Oxygen
- Nebulisedadrenaline
- Intubationandventilation
9
Q
What causes acute asthma in children?
A
Could be triggered by any of the typical asthma triggers, such as infection, exercise or cold weather
10
Q
What is the typical presentation of acute asthma in children?
A
- Progressively worsening shortness of breath
- Tachypnoea
- Signs of respiratory distress
- Expiratory wheezeon auscultation heardthroughout the chest
- The chest can sound ‘tight’ on auscultation, with reduced air entry
11
Q
What is a sound when breathing out called?
A
Wheeze
12
Q
What is a sound when breathing in called?
A
Stridor
13
Q
What is the management of mild acute asthma?
A
Can be managed as an outpatient with regular salbutamol inhalers via a spacer (e.g. 4-6 puffs every 4 hours)
14
Q
What is the management of moderate-severe acute asthma?
A
- Oxygen (at least 60%)
- Salbutamol (neb)
- Oral prednisolone/IV Hydrocortisone
- Ipratropium (neb)
- Theophylline (oral)
- Magnesium sulphate (IV)
- An anaesthetist (to intubate)
15
Q
What is pneumonia?
A
Infection of the lung tissue, causing inflammation of the lungs and sputum filling the airways and alveoli
16
Q
What are the causes of pneumonia in children?
A
- Bacterial - Streptococcus pneumonia is most common, others include Group A and B strep, Staph. aureus and H. influenza
- Viral - RSV is the most common viral cause
17
Q
What is encephalitis?
A
Inflammation of the brain
18
Q
What causes encephalitis?
A
- Most commonly due to viral infection
- HSV is most common
- Other causes include: VZV, cytomegalovirus, EBV, enterovirus, adenovirus, influenza viru
19
Q
What is meningitis?
A
Inflammation of the meninges (lining of the brain and spinal cord)
20
Q
What causes meningitis?
A
- Bacterial - Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus) in children and adults, group B strep in neonates
- Viral - herpes simplex virus (HSV), enterovirus and varicella zoster virus (VZV)
21
Q
What is the presentation of pneumonia in children?
A
- Cough(typically wet and productive)
- High fever(> 38.5ºC)
- Tachypnoea
- Tachycardia
- Increased work of breathing
- Lethargy
- Delirium (acute confusion associated with infection)
- Bronchial breath sounds - harsh breath sounds that are equally loud on inspiration and expiration, caused by consolidation of the lung tissue around the airway
- Focal coarse crackles- caused by air passing through sputum
- Dullness to percussion- due to lung tissue collapse and/or consolidation
22
Q
What are the investigations for pneumonia in children?
A
- CXR
- Blood cultures if signs of sepsis
23
Q
What is the management of pneumonia in children?
A
- Amoxicillin first line
- Macrolide antibiotics e.g. erythromycin can be added to cover atypical pneumonia, or as a monotherapy in penicillin allergic patients
24
Q
What is the presentation of encephalitis?
A
- Altered consciousness
- Altered cognition
- Unusual behaviour
- Acute onset of focal neurological symptoms
- Acute onset of focal seizures
- Fever
25
What is the main investigations for encephalitis?
Lumbar puncture and imaging
26
What is the management of encephalitis?
Antiviral medications - aciclovir treats HSV and VZV
27
What is the presentation of meningitis?
- Fever
- Neck stiffness
- Vomiting
- Headache
- Photophobia
- Altered consciousness and seizures
- Abscence of a rash does not exclude meningitis
28
What is the investigation for meningitis?
Lumbar puncture
29
What is the management of bacterial meningitis?
- Under 3 months - cefotaxime plus amoxicillin
- Above 3 months - ceftriaxone
- If penicillin allergic: chloramphenicol
- Steroids e.g. dexamethasone are also used in bacterial meningitis to reduce the frequency and severity of hearing loss and neurological damage
30
What is the management of viral meningitis?
- Tends to be milder and often only requires supportive treatment
- Aciclovir can be used to treat suspected or confirmed HSV or VZV infection
31
What are febrile seizures?
- Type of seizure that occurs in children with a high fever e.g. due to underlying viral illness or bacterial infection
- Occur only in children between the ages of 6 months and 5 years
- In order the make a diagnosis of a febrile convulsion, other neurological pathology must be excluded e.g. epilepsy, meningitis, brain tumour
32
What is the management of febrile seizures?
- Identify and manage underlying infection
- Control the fever with simple analgesia such as paracetamol and ibuprofen
- Reassure parents
33
What are vasovagal episodes?
- Most common cause of syncope in children
- Type of reflex syncope, involves vagal stimulation triggered by emotional distress or orthostatic stress
34
What are triggers of vasovagal episodes?
Typical triggers include: prolonged standing, emotional stress, pain, the sight of blood
35
What other symptoms are present in vasovagal episodes?
pallor, sweating and nausea
36
What is the management of vasovagal episodes?
- Reassurance
- Education - avoidance of triggers, how to avert faint through manoevers to increase venous return e.g. horizonal gravity neutralisation position
37
What are reflex anoxic seizures?
- Occur when the child is startled, most commonly a minor bump to the head
- The vagus nerve sends strong signals to the heart that causes it to stop beating
- The child will suddenly go pale, lose consciousness and may start to have some seizure-like muscle twitching
- Within 30 seconds the heart restarts and the child becomes conscious again
38
What is the management of a reflex anoxic seizures?
After excluding other pathology and making a diagnosis, educating and reassuring parents is the key to management
39
What are breath holding attacks?
- Involuntary episodes during which a child holds their breath, usually triggered by something upsetting or scaring them
- They typically occur between 6 and 18 months of age and most children outgrow them between by 4 or 5 years
- May breath out when crying and then forgot to breath in again
40
What is the management of breath holding attacks?
After excluding other pathology and making a diagnosis, educating and reassuring parents is the key to management
41
What is epilepsy?
- Umbrella term for a condition where there is a tendency to have seizures
- Seizures are transient episodes of abnormal electrical activity in the brain
- Investigations include EEG and MRI brain
42
What is the management of epilepsy?
- Education about how to manage seizure
- Anti-epileptic medication
43
What are congenital heart disease in children?
Defect in the structure of the heart or great vessels that is present at birth
44
What is the presentation of congenital heart disease in children?
- Depends on type of defect, can vary from no symptoms to life-threatening
- When present, symptoms may include:
- Tachypnoea
- Cyanosis
- Poor weight gain
- Feeling tired
- Can progress to heart failure
45
What is the most common rhythm disturbance in children?
Supraventricular Tachycardia
46
What are the main types of SVT in children?
- atrial fibrillation,
- paroxysmal supraventricular tachycardia (PSVT),
- atrial flutter,
- Wolff–Parkinson–White syndrome
47
What causes SVT in children?
Abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart
48
What is the presentation of SVT in children?
- Palpitations
- Dyspnoea
- Chest pain
- Rapid breathing
- Dizziness
- Loss of consciousness
- Heart rate of 150–270bmp during an episode
49
What is seen on this ECG?
supraventricular tachycardia
50
What are common accidents and trauma in children?
- 'Age specific'
- RTA
- Trampoline, sports injuries
- Burns
- Ingestion - accidental (more common) or intentional
- Drowning, near drowning
- Choking
- Always consider possibility of NAI
51
What is infective endocarditis?
Rare but severe bacterial infection of the heart valves
52
What causes infective endocarditis?
- Gram-positive bacteria represent the majority of organisms responsible for pediatric IE - includes viridans group streptococci, staphylococci and enteroccoci
- Can also be caused by gram-negatives and fungi
53
What is the presentation of infective endocarditis?
- Most cases of pediatric endocarditis present subacutely - low-grade fever, malaise, myalgias, arthralgias, and headaches
- New or changing heart murmur may be auscultated
54
What is the management of infective endocarditis?
Obtain culture, then start empirical antibiotics, transition to specific antibiotics based on culture results
55
What is gastroenteritis?
Inflammation all the way from the stomach to the intestines
56
What is the cause of gastroenteritis?
Most commonly viral - rotavirus, norovirus
57
What is the typical presentation of gastroenteritis?
- Nausea
- Vomiting
- Diarrhoea
58
What is the management of gastroenteritis?
Ensure patient remains hydrated while waiting for diarrhoea and vomiting to settle - aim for oral rehydration, may require IV fluids
59
What is congenital pyloric stenosis?
Narrowing of the opening from the stomach to the first part of the small intestine (the pylorus)
60
What is the typical presentation of congenital pyloric stenosis?
- Projectile vomiting without the presence of bile (vomiting milk), most often occurs after the baby is fed
- Keen to feed
- The typical age that symptoms become obvious is two to twelve weeks old, most commonly 6 weeks
- Signs of dehydration
- Peristalsis across the abdomen
- May feel abdomen mass
61
What investigations should be done for congenital pyloric stenosis?
US scan upper abdomen
62
What is the management of congenital pyloric stenosis?
Surgery - pyloromyotomy (open or lap)
63
What is volvulus?
Loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction
64
What causes a volvulus?
- Congenital intestinal malrotation predisposes to midgut volvulus
- Abnormal intestinal contents e.g. meconium ileus can predispose to segmental volvulus
65
What is the typical presentation of volvulus?
- Abdominal pain
- Abdominal bloating
- Vomiting bile - green
- Constipation
- Bloody stool
66
What investigations should be done for volvulus?
AXR
67
What is the management of volvulus?
Surgery
68
What is intussusception?
The bowel 'invaginates' or 'telescopes' into itself, narrowing the lumen, which results in a palpable mass in the abdomen and obstruction to the passage of faeces through the bowel
69
What is the presentation of intussusception?
- Severe, colicky abdominal pain
- Pale, lethargic and unwell child
- Vomiting
- Signs of dehydration
- 'Redcurrant jelly stool'
- Right upper quadrant mass on palpation
- Can be associated with concurrent viral illness
70
What is the investigation for intussusception?
USS - target sign
71
What is the management for intussusception?
- Air reduction - relieves obstruction in >85% of cases
- Surgical reduction if non-invasive measures fail
72
What is appendicitis?
Inflammation of the appendix; main differential for an acute abdomen presentation in a child
73
What is the presentation of appendicitis?
- The key presenting feature of appendicitis is abdominal pain - typically starts as central abdominal pain, that moves down to the right iliac fossa over time and eventually becomes localised in the RIF
- Other classic features are:
- Anorexia
- Nausea and vomiting
- Moderate temperature
- Tenderness in McBurney’s point
- Rosving’s sign - palpation of the left iliac fossa causes pain in the RIF
- Guarding on abdominal palpation
- Rebound tenderness - increased pain when quickly releasing pressure on the right iliac fossa
- Percussion tenderness - pain and tenderness when percussing the abdomen
- Painful movements (can't jump, feels every bump on the way to hospital) suggests peritonitis
74
What is the investigations for appendicitis?
- Usually clinical diagnosis based on presentation and raised inflammatory markers
- US abdomen may find the inflamed appendix - good test in children if diagnosis uncertain
75
What is the management for appendicitis?
Appendicectomy
76
What is a UTI?
Infections anywhere along the urinary tract - urethra, bladder, ureters and kidneys
77
What is the aetiology of UTI in children?
- More common in girls
- Consider abnormal renal tract in children with repeat UTIs
78
What is the presentation of UTI in babies?
Babies will present with very non-specific symptoms:
- Fever
- Lethargy
- Irritability
- Vomiting
- Poor feeding
- Increased urinary frequency
79
What are the signs and symptoms of UTI in children?
- Fever
- Abdominal pain, particularly suprapubic pain
- Vomiting
- Dysuria (painful urination)
- Increased urinary frequency
- Incontinence
80
What are the investigations for a UTI?
Urine clean catch sample with microbiology
81
What is the management of UTI in children?
- All children under 3 months with a fever should start immediate IV antibiotics
- Oral antibiotics can be considered in children over 3 months if they are otherwise well
- Children with features of sepsis or pyelonephritis (infection affecting kidney function) will require inpatient treatment with IV antibiotics
82
What is torsion of testes?
- Occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum
- Typically in teenage boys, but can occur at any age
83
What is the management for torsion of the testes?
Surgery
84
What is epididymoorchitis?
Acute bacterial infection of the epididymis progressing to involve the testis which occurs as a result of retrograde bacterial colonisation via the ejaculatory ducts and vas deferens
85
What is the management of epididymoorchitis?
Analgesia and antibiotics
86
What is torsion of the appendix testes?
The appendix testis is located at the upper pole of the testis (between the testis and the head of the epididymis)
87
What is the management of torsion of appendix testes?
Conservative or surgical depending on symptoms
88
What is hydrocele?
Collection of fluid within the tunica vaginalis that surrounds the testes
89
What is the presentation of hydrocele?
- Soft, smooth, non-tender swelling around one of the testes
- Transilluminate with light on examination with a pen torch
90
What is the management of hydrocele?
- Simple hydroceles (no connection with peritoneal cavity) usually resolve within 2 years without having any lasting negative effects
- Communicating hydroceles (have a connection with the peritoneal cavity) are managed surgically
91
What is an inguinal hernia?
Part of the bowel pushes through a weakness in the abdominal muscles
92
What is the presentation of inguinal hernia?
Soft lump in the inguinal region (in the groin)
93
What is the management of inguinal hernias?
Surgical correction
94
What are undescended testes?
In about 5% of boys the testes have not made it out of the abdomen by birth; at this point they are called undescended testes
95
What is the presentation of undescended testes?
- Empty scrotum
- Testes may be palpable on physical examination
96
What is the management of undescended testes?
- Watching and waiting is appropriate in newborns - in most cases the testes will descend in the first 3-6 months
- Surgical correction should be carried out between 6 and 12 months of age if testes still have not descended
