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RB Y2 Child Health > Acutely Ill Child > Flashcards

Acutely Ill Child Flashcards

1
Q

what cause should be considered for obesity in very overweight child with short stature

A

endocrine cause

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2
Q

what are the concerning features of a child witha UTI

A
  • younger
  • frequent
  • E coli pathogens
  • FH of renal disease
  • poor growth and general health
  • poor urinary flow
  • urinating problems
  • constipation
  • spinal abnormality
  • raised BP
  • abdominal mass
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3
Q

encopresis

A

passage of normal stools in abnormal places

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4
Q

treatment of constipation

A

laxatives, food and drink attention, toileting behaviour advice

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5
Q

what is a red flag concerning passage of meconium

A

delay in passage of meconium >24 hours after birth may signal intesintal obstruction

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6
Q

features of CF in neonate

A
  • Meconium ileus – surgical emergency
  • Abnormally prolonged jaundice
  • Malabsorption, steatorrhoea, failure to thrive
  • Recurrent chest infections
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7
Q

bristol stool chart

A
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8
Q

headache red flags

A
  • headache on waking
  • worse with coughing or bending
  • assoicated vomiting, especially in morning
    • thinking raised ICP?
  • visual disturbance
  • gait disturbance
  • CN palsy
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9
Q

red flags for cardiac syncope

A
  • known congenital heart disease
  • during exercise/when supine
  • FH of sudden death, prolonged QT or HCM
  • preceded by palpitations
  • heart murmur or other CV abnormalities
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10
Q

5 associated symptoms with murmurs

A
  • breathlessness
  • blue
  • pale
  • sweaty
  • poor feeding
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11
Q

red flag symptoms for murmurs

A
  • diastolic - systolic is innocent
  • loud - grade ≥3
  • associated thrill
  • harsh
  • radiate widely
  • other symptoms
  • poor growth
  • FH
  • syncope
  • sweating
  • pallor
  • poor feeding
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12
Q

innocent murmurs

A
  • systolic, soft, short, symptomless, standing/sitting (vary with position), low intensity, 2nd left interspace, medial to apex, beneath either clavicle
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13
Q

specific childhood murmurs:

  • coarctation of aorta
  • VSD
  • ASD
  • pulnonary stenosis
A
  • Coarctation of aorta: Ejection systolic murmur that can be heard through to the back
  • VSD: Pansystolic murmur
  • ASD: Ejection systolic murmur, splitting of 2nd heart sound
  • Pulmonary stenosis: Ejection systolic heard at left upper parasternal edge
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14
Q

compare food intolerance to allergy

A
  • food allergy is a type I IgE mediated reaction - occurs rapidly
  • food intolerance is a delayed reaction, and has more varied symptoms
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15
Q

what is measured on a childs head

A

occipitofrontal circumference

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16
Q

respiratory rate in children

A
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17
Q

signs of work of breathing

A
  • Tracheal tug
  • Nostril flare
  • Accessory muscle use
  • Intercostal recession
  • Sternal recession
  • Grunting
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18
Q

what are common surgical problems in children up to one year

A
  • intussception
  • volvulus
  • incarcerated hernia
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19
Q

what are common surgical problems in children from 2-5 years

A
  • intuscception
  • volvulus
  • appendicitis
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20
Q

what are common surgical presentations in children from 6 to 18

A
  • appendicitis
  • trauma
  • testictular trauma
  • ovarian torsion
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21
Q

what should not be used to routinely measure temperature in children aged 0-5

A

oral and rectal routes

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22
Q

measuring temperature in children <4 weeks

A

electronic thermometer in the axilla

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23
Q

measuring temperature in children aged 4weeks to 5 years

A
  • Electric thermometer in axilla
  • Chemical dot thermometer in axilla
  • Infra-red tympanic thermometer
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24
Q

what is childrens sitting height like

A

proportionally more

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25
Q

how do childrens heads differ

A

relatively large and prominent occiput

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26
Q

sepsis in children

A

initial clinical presentation may be non-specific, and may progress to organ failure and shock very rapidly

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27
Q

bronchiolitis

A
  • inflammation of the bronchioles
  • RSV, also metapneumovirus
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28
Q

clinical features of bronchiolitis

A
  • dry cough, wheezing, fever, grunting
  • intercostal/sternal in drawing in severe cases
  • hyperinflation
  • atelectasis
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29
Q

treatment of bronchiolitis

A

supportive

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30
Q

croup

A
  • Laryngotracheobronchitis – infection of any of this area
  • Usually viral, can be bacterial
    • Caused by parainfluenzae virus
  • oral steroid treatment
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31
Q

features of croup

A
  • barking cough – severely distressed and cough associated with a harsh sound while breathing. Signs of moderate respiratory distress.
  • narrowing of air column and hypopharynx distension - steeple sign on x ray
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32
Q

mangement of croup

A

oral steroids

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33
Q

widespread wheeze and clinical/family history of atopy etc

A

asthma

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34
Q

pertussis presentation

A
  • inspiratory whoop/barking cough
  • this can be described as the child seeming unable to breath after coughing fit
  • caused by forced inspiration against a closed glottis
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35
Q

what does bilious vomiting indicate

A

initial sign of intestinal obstruction, with/out abdominal distension

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36
Q

how does viral gastoenteritis present

A
  • diarrhoea and may cause vomiting and abdominal pain
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37
Q

what is the most common cause of viral gastroenteritis

A

rotavirus

typically accompanied by fever

38
Q

treatment of viral gastroenteritis

A

usually self limiting

the main risk is dehydration so give oral rehydration solutions

39
Q

what can often occur for a while after viral gastroenteritis

A

bloating, abdominal pain, watery stools after drinking milk

40
Q

presentation of pyloric stenosis

A
  • Presents as two lumps in the upper abdomen, visibly peristalsing.
  • Child will be vomiting as the pyloric muscle is closing down the pathway from the stomach to the duodenum. Projectile vomiting typically follows meals by 30 minutes, and the infant is hungry afterwards.
  • Constipation and dehydration may also be present
  • Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
41
Q

at which age does Pyloric Stenosis usually present

A

2-6 weeks

42
Q

infantile colic

  • presentation
  • age
A
  • 2-6 weeks
  • paroxysms of crying
  • normal examination
43
Q

cows milk protein intolerance

A

diarrhoea proceeding vomiting

44
Q

what is the most common cause of chronic diarrhoea in children

A

cows milk protein intolerance

45
Q

galactosaemia

A
  • autosomal recessive metabolic condition that presents with failure to thrive and vomiting
  • sugar galactose
46
Q

how may galactosaemia present

A

detected by newborn Guthrie test

oil drop cataracts noted on examination

47
Q

presentation of Intussusception

A
  • pain, drawing legs up to abdomen and then a pahse of limpness and relaxing
  • sausage shaped abdominal mass that is palpable
  • crying, colic
  • currant jelly stool and bullseye appearance on US
48
Q

most common cause of Intussusception in children

A

lymphoid hyperplasia due to rotavirus

49
Q

malrotation

A

childs intestines are not in the normal position

50
Q

what may malrotation lead to

A
  • volvulus
  • complete twisting of a loop of intestine
  • obstruction of blood supply leading to infarction
  • can become gangrenous
51
Q

how does volvulus present

A
  • acutely, abdominal pain, distension and constipation
  • green/yellow vomit - bilious
52
Q

how does malrotation present (and at what age)

A
  • usually before one year
  • present with intermittent symptoms of obstruction:
    • green/yellow vomit
    • crying and fussy
    • feeding intolerance
    • lethargy
    • swollen, tender abdomen
    • fever
    • tachycardia and tachypnoea
53
Q

investigation of malrotation/volvulus

A

abdominal X ray is first line

54
Q
  • Child vomiting, small amounts, effortless, after almost every feed
  • Gaining weight appropriately
  • No other abnormalities/excessive crying etc.
A
  • mild GOR
55
Q

what is the meconium

A

the first stool that a child has, thick and sticky

56
Q

what does delay in pasage of teh first stool by 24 hours indicate

A

intestinal obstruction

57
Q

meconium ileus

A
  • child’s stool is thicker and stickier than usual so creates a blockage in the ileum
  • earliest signs are abdominal distension, bilious vomit and no passage of meconium
58
Q

what do most children with meconium ileus also have

A

CF

59
Q

what is required for assessment of jaundice

A

well lit room

60
Q

presentation of jaundice

A
  • pale stool, dark urine
  • yellow skin that doesnt blanch
61
Q

what is the cause of jaundice in a 5 day old baby that has no other abnormalities

A

physiological - baby is adapting to using its own liver

62
Q

define prolonged jaundice

A

longer than 14 days in term infants, and 21 days in preterm infants

63
Q

what can cause prolonged jaundice

A

obstructive jaundice

64
Q

pathological cause of jaundice in the first 24 hours

A
  • hepatitis, ABO incompatibility, sepsis, G6PD deficiency (suspect in likely genetic cases)
65
Q

pathological cause of jaundice from 24h to 2 weeks

A
  • haemolysis, polycythaemia, infection (can be acquired during birth e.g. STI, UTI), dehydration, gut obstruction
66
Q

pathological causes of jaundice 2 weeks after birth

A
  • poor milk intake
  • infection
  • hypothyroid
  • biliary atresia
67
Q

investigation of jaundice in infant

A

LFT, bloods

68
Q

what can be used to treat physiological jaundice

A

phototherapy

69
Q

complication of jaundice

A

a prolonged increase in bilirubin can cause it to cross the BBB where it is toxic and can cause bilirubin encephalopathy

70
Q

epiglottitis

A
  • Epiglottitis is an inflammation of the epiglottis with the potential to cause airway compromise, and should be treated as a surgical emergency until the airway is examined and secured.
  • Clinical presentation: drooling, short history, unwell, high fever, audible stridor
    • Tachypnoea, tachycardia
    • Cervical lymphadenopathy
71
Q

x ray of epiglottitis

A

thumb print sign on x ray

72
Q

management of epiglottitis

A
  • Treat with ceftriaxone, as H. influenzae B is often ß-lactamase resistant (amoxicillin usually), and this is a severe situation
73
Q

which investigations should be avoided in epiglottitis

A
  • Avoid endoscopy if suspected. Do not touch with tongue depressor
74
Q

presentation of meningitis

A
  • Purpuric rash
  • Photophobic
  • Headache, stiff neck
  • Fever, vomiting, irritability, lethargy
  • prolonged cap refill
75
Q

investigations of meningitis

A
  • FBC
  • blood culture
  • lumbar puncture
  • imaging
  • blood glucose and coagulation screen are often used in 2y care for those with suspected meningitis
76
Q

what must be done before a lumbar puncture

A

clotting screen

77
Q

when would a lumbar puncture be performed for meningitis

A
  • contraindicated in meningococcal septicaemia and any signs of raised ICP
    • eg bulging fontanelle
78
Q

management of meningitis

A
  • ABCDE, ABx, steroids
  • notify public health
79
Q

identification of meningococcal rash and its implications

A
  • glass tumbler test
  • implies significant septicaemia
80
Q

investigations of suspected NAI

A
  • bloods
  • bone density DEXA scan and clotting
  • plain X ray - full skeletal survey
    • to look for old breakages
81
Q

which 3 professions need to be contacted in suspected NAI

A
  • social worker
  • child protection
  • paediatrician
82
Q

risk factors for NAI

A
  • Low birthweight
  • Mum<30
  • Unwanted pregnancy
  • Stress
  • Poverty
83
Q

features that raise suspicion of NAI

A
  • Inconsistent / changing history of events
  • Discrepancy of history between parents / carers
  • History not consistent with injury
  • Injuries not consistent with age of child e.g. non-walking child
  • Multiple bruises of varying ages
  • Atypical injuries e.g. cigarette burns, genital injuries, torn frenulum, dental injuries, lower limb and trunk burns
  • Rib fractures – particularly those of the posterior ribs
  • Metaphyseal fractures in infants
  • Torn frenulum
84
Q

which fracture in particular raises suspicion of NAI

A

posterior ribs

85
Q

tetralogy of fallot

A

low oxygenation of blood due to mixing through VSD - cyanosis on first day of life

86
Q
A
87
Q

continuous machine like murmur below left clavicle

A

patient ductus arteriosus

88
Q

what is the ductus arteriosus a remnant of

A

ligamentum arteriosum

89
Q

egg shaped ventricles

A

transposition of great vessels

90
Q

2 signs of coarctation of the aorta

A
  • rib notching on CXR
  • radio femoral delay

RB Y2 Child Health (7 decks)

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