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Y4 Child Health > Acutely Unwell Child > Flashcards

Acutely Unwell Child Flashcards

1
Q

Low blood pressure is a late or early sign in the acutely unwell child

A

Late

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2
Q

Resuscitation, initially how many rescue breaths? Then what ratio : chest compressions?

A

5 rescue breaths

Then 15:2 compressions

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3
Q

What are the emergencies for same day referral from primary care to hospital?

A

T1DM
No meconium past 24hr
Bile stained vomit

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4
Q

For resuscitation for the acutely unwell child, how much fluid is given initially? What % of their circulating vol does this replace?

A

20ml/kg bolus
Replaces 25%
Then reassess + repeat

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5
Q

In appendicitis is there a mildly elevated or very high WCC? Mildly elevated or very temperature? What age group is commonest? Other than bloods what investigation is done first?

A

Mildly elevated WCC
Low grade pyrexia
10–20yr
US

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6
Q

What diagnosis shouldn’t be messed in boys with abdominal pain?

A

Torsion

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7
Q

Describe the nature, location and exacerbating features of the pain in appendicitis

A

Poorly localised colicky periumbilical pain migrates to RIF, exacerbated by movement – pain on speed bump

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8
Q

Do all children with appendicitis get a CT scan?

A

No, only if diagnostic uncertainty

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9
Q

“explosive passage of stool following PR exam”

A

Hirschsprung’s disease

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10
Q

“absent innovation to large bowel”

A

Hirschsprung’s disease

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11
Q

At what age does intussception present?

A

6mth

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12
Q

At what age does pyloric stenosis present?

A

2-8wk

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13
Q

“Projectile vomiting 30-60min after a feed, hungry baby, weight loss, visible peristalsis”

A

Pyloric stenosis

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14
Q

Is the vomit bilious or non-bilious in pyloric stenosis?

A

Non-bilious

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15
Q

What test is done for diagnosis of pyloric stenosis?

A

US

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16
Q

What is the management of pyloric stenosis?

A

Pyloromyotomy

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17
Q

red current jelly stool … caused by?

A

Intussception

there may also be no stool

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18
Q

What is seen on US in intussusception?

A

Target sign/kidney bean

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19
Q

What is the management of intussusception?

A

XR guided air reduction

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20
Q

What is the basic mechanism of intussusception?

A

Terminal ileum/ileocecal junction telescoping folds in on self

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21
Q

Sausage shaped mass in the right upper quadrant is a sign of?

A

Intussusception

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22
Q

Where is volvulus in the paediatric age group?

A

Caecal

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23
Q

Is the vomit bilious or non-bilious in volvulus malrotation?

A

Bilious green - yellow

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24
Q

What condition is meconium ileus associated with?

A

CF

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25
Q

In a child with meconium alias, what test is done to look for cystic fibrosis?

A

Sweat test

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26
Q

What is the management of meconium ileus?

A

Surgical

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27
Q

What is the management of malrotation volvulus?

A

ASAP surgery

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28
Q

At what age does meconium ileus present?

A

First 24hr

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29
Q

Is the vomit bilious or non-bilious in meconium ileus?

A

Bilious

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30
Q

What type of seizure are febrile convulsions most commonly?

A

Tonic clonic

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31
Q

Is there post-ictal confusion in febrile convulsions?

A

Yes

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32
Q

What is the rate of febrile convulsion recurrence?

A

1/3

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33
Q

What are risk factors for febrile convulsions being more likely to recur?

A

Age <18mth, fever <39, shorter duration of fever before seizure

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34
Q

During what age can febrile convulsions occur?

A

6mth - 5yr

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35
Q

A seizure below what age is a red flag?

A

Before 1yr - consider other causes eg infantile spasms

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36
Q

All children with a first seizure should be admitted to paediatrics - true or false

A

True

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37
Q

Parents should be advised to phone for an ambulance if a seizure lasts longer than X minutes

A

5

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38
Q

Do regular antipyretics eg paracetamol reduce the change of a febrile seizure occurring?

A

No

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39
Q

Are complex febrile seizures a risk factor for epilepsy?

A

Yes

most febrile convulsions are simple seizures

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40
Q

“EEG shows centro-temporal spikes activated by sleep”

A

Benign rolandic epilepsy

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41
Q

EEG spike and wave pattern

A

Childhood absence epilepsy

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42
Q

Do simple or complex febrile convulsions require further investigations?

A

Simple require no further investigations

complex seizure if lasts <15min, 2 seizures in same viral illness or focal neurology

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43
Q

Parents of children who have had a febrile convulsion should be given safety advice for managing a seizure, what is this?

A

Staying with the child, putting the child in a safe place eg on carpeted floor with pillow under their head, place in recovery position and away from potential sources of injury. Don’t put anything in their mouth. Call ambulance if seizure last >5min

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44
Q

What is the change of a child developing epilepsy? What is the chance for a simple febrile convulsion developing into epilepsy? What is the chance for a complex febrile convulsion developing into epilepsy?

A

1.8% for general population
2-7% for simple febrile convulsion
10-20% after complex febrile convulsion

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45
Q

Hypogylcaemia can cause seizures - true or false

A

True

46
Q

What is the management of status epilepticus?

A

1st line IV lorazepam in hospital or rectal diazepam in community
2nd line repeat IV lorazepam after 10mins
3rd line IV phenytoin (phenobarbitone if already taking phenytoin)

47
Q

Epilepsy investigations - when is an EEG required?

A

Everyone gets an EEG

48
Q

Epilepsy investigations - when is CT required

A

Only in the acute situation if low GCs or focal sign

49
Q

Epilepsy investigations - when is MRI required

A

If <2yr old or focal epilepsy or treatment resistant

50
Q

There is no routine imaging for idiopathic generalised childhood epilepsy - true or false

A

True

51
Q

Juvenile myoclonic epilepsy mostly occurs in children or adolescents?

A

Adolescents

52
Q

What is the drug of choice for nephrotic syndrome in a child?

A

Steroid

53
Q

What infection is HUS associated with?

A

e coli 0157

54
Q

HUS - thrombocytosis or thrombocytopenia?

A

Low platelets

55
Q

Kawasaki disease

  • what race most common in
  • pyrexia or apyrexic
  • what rash seen?
  • what sign on the face?
  • complications include what type of aneurysms
A

-Asian japanese
-High fever >39 (for >5 days)
-widespread erythematous maculopapular rash (and desquamation of palms/ soles)
-strawberry tongue (also cracked lips, cervical lymphadenopathy, bilateral conjunctivitis)
-coronary artery aneurysm (echo to look for)
(>WCC, >PLTs, LFTs, >CRP)

56
Q

What is one of the few scenarios where aspirin is used in children?

A

Kawasaki disease

57
Q

What is the risk when prescribing aspirin in children?

A

Reye’s syndrome (brain / liver damage)

58
Q

What is the Mx of Kawasaki disease?

A

High dose aspirin + IV Ig

59
Q

Bloody diarrhoea followed by kidney failure =

A

HUS

60
Q

What organism is the commonest cause of gastroenteritis in children in the UK?

A

Rotavirus

61
Q

Signs of dehydration in children

  • sunken eyes yes or no?
  • dry mucous membranes
  • high or low HR
  • high or low RR
  • normal or absent peripheral pulses
  • normal or prolonged CRT
  • increased or reduced skin turgor
  • normal or low BP
A 
Sunken eyes
Dry mucous membranes
High HR
High RR
Normal peripheral pulses (absent = shock)
Normal CRT (absent = shock)
Reduced skin turgor
Normal BP (low = shock)
62
Q

Is hypo or hypernatraemia a comp of D&V in children?

A

Hypernatraemia

63
Q

Nocturnal back pain is a red flag - true or false

A

True - requires urgent MRI

64
Q

Back pain with midline tenderness is a red flag - true or false

A

True - requires urgent MRI

65
Q

If back pain has any red flags, what should be done?

A

Urgent MRI double check its not a XR

66
Q

Neural tube defect causing only a hairy tuft is a…

A

Spina bifida occulta

67
Q

Neural tube defect causing herniation of meninges is a…

A

Meningocele

68
Q

Neural tube defect causing herniation of meninges and spinal cord is a…

A

Myelomeningocele

69
Q

In raised ICP are pupils dilated or constricted?

A

Dilated

70
Q

What effect does raised ICP have on HR, BP, pupil response to light?

A

Low HR
High BP
Poor response to light

71
Q

Unsure how much to learn about decorticate and decerebrate posturing

A

IDK

72
Q

Flexed arms, clenched fists, extended legs and inverted feet =

A

Decorticate posturing

73
Q

Extended arms + legs + head =

A

Decerebrate posturing

74
Q

In what time frame can activated charcoal be used in the management of paracetamol overdose?

A

Within 1hr of ingestion

75
Q

NAC is used for all paracetamol overdoses - true or false

A

False - calculate mg per kg (eg 32 500mg tablets in a 50kg adult = 266mg/kg)
(start NAC generally if >75mg/kg)
(plot on treatment line nomogram - give NAC if on or above line)

76
Q

Ramsay Hunt syndrome is due to ….

A

Shingles of CN VII

77
Q

Is there fever in Ramsay Hunt syndrome?

A

No fever

78
Q

Is there otorrhoea in Ramsay Hunt syndrome?

A

No

79
Q

What is the management of Ramsay Hunt syndrome?

A

Aciclovir + prednisolone

80
Q

What empirical antibiotics are given for neonatal sepsis?

A

IV cef + amox

81
Q

A purpuric non-blanching rash is a sign of bacterial meningitis - true or false

A

Only a sign of meningococcal meningitis

82
Q

Group B strep cause meningitis in what age group?

A

0 - 3 months

83
Q

The gold standard investigation for meningitis in children is LP - true or false

A

Well yes but LP is contraindicated if focal neurological sign, papilloedema, DIC, sign of herniation, bulging fontanelles

84
Q

How is meningococcal disease diagnosed?

A

Blood cultures + PCR for pneumococcus

85
Q

What happens first in meningitis - LP or ABx?

A

ABx first

86
Q

Name 3 organisms in bacterial meningitis in children?

A

Meningococcal
Strep pneumoniae
Haemophilus influenzae

87
Q

Meningitis can cause focal neurological signs - true or false

A

True

88
Q 
LP in bacterial meningitis
-Glucose?
-WCC?
-Protein?
Also do culture PCR
A

Low glucose
High WCC
High protein
(also cloudy colour)

89
Q

What is the empirical Mx of meningitis in children older than 3mth?

A

IV ceftriaxone
(add IV dexamethasone if confirmed bacterial)
(if <3mth IV cef + amox)

90
Q

LP in encephalitis

  • Glucose?
  • WCC?
  • Protein?
A

Normal glucose
High protein
High WCC

91
Q

What is the commonest infecting organism in encephalitis?

A

HSV-1

92
Q

What brain lobe is most affected in HSV encephalitis?

A

Temporal lobe

93
Q

What is the Mx of HSV encephalitis?

A

IV aciclovir

94
Q

Gastroenteritis is mainly viral or bacterial?

A

Viral

95
Q

Diarrhoea definition

A

3 loose stools in 24hr

96
Q

What is the most important complication of gastroenteritis in children?

A

Dehydration

97
Q

What are the components of the sepsis 6?

A

O2, fluids, ABx

BC, UO, lactate

98
Q

What volume of fluid is given in a fluid bolus?

A

20ml/kg over 5 - 10 min

99
Q

What scan is done first for recurrent UTIs in children?

A

US (then DMSA)

100
Q

A UTI in children could present with loss of appetite, clinginess and lethargy - true or false

A

True

101
Q

What is the 1st line Mx of pyelonephritis in a child?

A

IV amox + genta

102
Q

What is the 1st line Mx of a lower UTI in a child?

A

PO trimethoprim or PO nitrofurantoin

103
Q

What are the indications for tonsillectomy?

A

tonsillitis disabling, >7 in 1yr OR 2X 5 in 1yr

passmed says otherwise

104
Q

What is the commonest organism in tonsillitis?

A

Strep pyogenes

105
Q

What diagnostic criteria are used for tonsillitis?

A 
CENTOR
Age <15 
Tonsillar exudate
Fever
No cough
Tender cervical lymphadenopathy
106
Q

When do you give antibiotics for tonsillitis? What is the antibiotic of choice?

A

If CENTOR >3

Pencillin V

107
Q

What is the management of quinsy?

A

Needle aspiration OR incision / drainage

+ IV ABx

108
Q

What is used as ABx therapy for close contacts of confirmed meningococcal disease?

A

Oral ciprofloxacin

109
Q

What is the 1st and 2nd line ABx of choice in acute otitis media?

A

1st amox

2nd clarithromycin

110
Q

What is seen on otoscopy in acute otitis media?

A

Air fluid level behind red tympanic membrane

111
Q

Add infectious mononucleosis notes

A

Add it

112
Q

Meningococcal sepsis is a contraindication to lumbar puncture - true or false

A

True (not to do with raised ICP - the coagulopathy in meningococal implies DIC - so LP would cause bleeding)

Y4 Child Health (6 decks)

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