Acutely Unwell Child Flashcards
Low blood pressure is a late or early sign in the acutely unwell child
Late
Resuscitation, initially how many rescue breaths? Then what ratio : chest compressions?
5 rescue breaths
Then 15:2 compressions
What are the emergencies for same day referral from primary care to hospital?
T1DM
No meconium past 24hr
Bile stained vomit
For resuscitation for the acutely unwell child, how much fluid is given initially? What % of their circulating vol does this replace?
20ml/kg bolus
Replaces 25%
Then reassess + repeat
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?
Mildly elevated WCC
Low grade pyrexia
10–20yr
US
What diagnosis shouldn’t be messed in boys with abdominal pain?
Torsion
Describe the nature, location and exacerbating features of the pain in appendicitis
Poorly localised colicky periumbilical pain migrates to RIF, exacerbated by movement – pain on speed bump
Do all children with appendicitis get a CT scan?
No, only if diagnostic uncertainty
“explosive passage of stool following PR exam”
Hirschsprung’s disease
“absent innovation to large bowel”
Hirschsprung’s disease
At what age does intussception present?
6mth
At what age does pyloric stenosis present?
2-8wk
“Projectile vomiting 30-60min after a feed, hungry baby, weight loss, visible peristalsis”
Pyloric stenosis
Is the vomit bilious or non-bilious in pyloric stenosis?
Non-bilious
What test is done for diagnosis of pyloric stenosis?
US
What is the management of pyloric stenosis?
Pyloromyotomy
red current jelly stool … caused by?
Intussception
there may also be no stool
What is seen on US in intussusception?
Target sign/kidney bean
What is the management of intussusception?
XR guided air reduction
What is the basic mechanism of intussusception?
Terminal ileum/ileocecal junction telescoping folds in on self
Sausage shaped mass in the right upper quadrant is a sign of?
Intussusception
Where is volvulus in the paediatric age group?
Caecal
Is the vomit bilious or non-bilious in volvulus malrotation?
Bilious green - yellow
What condition is meconium ileus associated with?
CF
In a child with meconium alias, what test is done to look for cystic fibrosis?
Sweat test
What is the management of meconium ileus?
Surgical
What is the management of malrotation volvulus?
ASAP surgery
At what age does meconium ileus present?
First 24hr
Is the vomit bilious or non-bilious in meconium ileus?
Bilious
What type of seizure are febrile convulsions most commonly?
Tonic clonic
Is there post-ictal confusion in febrile convulsions?
Yes
What is the rate of febrile convulsion recurrence?
1/3
What are risk factors for febrile convulsions being more likely to recur?
Age <18mth, fever <39, shorter duration of fever before seizure
During what age can febrile convulsions occur?
6mth - 5yr
A seizure below what age is a red flag?
Before 1yr - consider other causes eg infantile spasms
All children with a first seizure should be admitted to paediatrics - true or false
True
Parents should be advised to phone for an ambulance if a seizure lasts longer than X minutes
5
Do regular antipyretics eg paracetamol reduce the change of a febrile seizure occurring?
No
Are complex febrile seizures a risk factor for epilepsy?
Yes
most febrile convulsions are simple seizures
“EEG shows centro-temporal spikes activated by sleep”
Benign rolandic epilepsy
EEG spike and wave pattern
Childhood absence epilepsy
Do simple or complex febrile convulsions require further investigations?
Simple require no further investigations
complex seizure if lasts <15min, 2 seizures in same viral illness or focal neurology
Parents of children who have had a febrile convulsion should be given safety advice for managing a seizure, what is this?
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
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?
1.8% for general population
2-7% for simple febrile convulsion
10-20% after complex febrile convulsion
Hypogylcaemia can cause seizures - true or false
True
What is the management of status epilepticus?
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)
Epilepsy investigations - when is an EEG required?
Everyone gets an EEG
Epilepsy investigations - when is CT required
Only in the acute situation if low GCs or focal sign
Epilepsy investigations - when is MRI required
If <2yr old or focal epilepsy or treatment resistant
There is no routine imaging for idiopathic generalised childhood epilepsy - true or false
True
Juvenile myoclonic epilepsy mostly occurs in children or adolescents?
Adolescents
What is the drug of choice for nephrotic syndrome in a child?
Steroid
What infection is HUS associated with?
e coli 0157
HUS - thrombocytosis or thrombocytopenia?
Low platelets
Kawasaki disease
- what race most common in
- pyrexia or apyrexic
- what rash seen?
- what sign on the face?
- complications include what type of aneurysms
-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)
What is one of the few scenarios where aspirin is used in children?
Kawasaki disease
What is the risk when prescribing aspirin in children?
Reye’s syndrome (brain / liver damage)
What is the Mx of Kawasaki disease?
High dose aspirin + IV Ig
Bloody diarrhoea followed by kidney failure =
HUS
What organism is the commonest cause of gastroenteritis in children in the UK?
Rotavirus
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
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)
Is hypo or hypernatraemia a comp of D&V in children?
Hypernatraemia
Nocturnal back pain is a red flag - true or false
True - requires urgent MRI
Back pain with midline tenderness is a red flag - true or false
True - requires urgent MRI
If back pain has any red flags, what should be done?
Urgent MRI double check its not a XR
Neural tube defect causing only a hairy tuft is a…
Spina bifida occulta
Neural tube defect causing herniation of meninges is a…
Meningocele
Neural tube defect causing herniation of meninges and spinal cord is a…
Myelomeningocele
In raised ICP are pupils dilated or constricted?
Dilated
What effect does raised ICP have on HR, BP, pupil response to light?
Low HR
High BP
Poor response to light
Unsure how much to learn about decorticate and decerebrate posturing
IDK
Flexed arms, clenched fists, extended legs and inverted feet =
Decorticate posturing
Extended arms + legs + head =
Decerebrate posturing
In what time frame can activated charcoal be used in the management of paracetamol overdose?
Within 1hr of ingestion
NAC is used for all paracetamol overdoses - true or false
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)
Ramsay Hunt syndrome is due to ….
Shingles of CN VII
Is there fever in Ramsay Hunt syndrome?
No fever
Is there otorrhoea in Ramsay Hunt syndrome?
No
What is the management of Ramsay Hunt syndrome?
Aciclovir + prednisolone
What empirical antibiotics are given for neonatal sepsis?
IV cef + amox
A purpuric non-blanching rash is a sign of bacterial meningitis - true or false
Only a sign of meningococcal meningitis
Group B strep cause meningitis in what age group?
0 - 3 months
The gold standard investigation for meningitis in children is LP - true or false
Well yes but LP is contraindicated if focal neurological sign, papilloedema, DIC, sign of herniation, bulging fontanelles
How is meningococcal disease diagnosed?
Blood cultures + PCR for pneumococcus
What happens first in meningitis - LP or ABx?
ABx first
Name 3 organisms in bacterial meningitis in children?
Meningococcal
Strep pneumoniae
Haemophilus influenzae
Meningitis can cause focal neurological signs - true or false
True
LP in bacterial meningitis -Glucose? -WCC? -Protein? Also do culture PCR
Low glucose
High WCC
High protein
(also cloudy colour)
What is the empirical Mx of meningitis in children older than 3mth?
IV ceftriaxone
(add IV dexamethasone if confirmed bacterial)
(if <3mth IV cef + amox)
LP in encephalitis
- Glucose?
- WCC?
- Protein?
Normal glucose
High protein
High WCC
What is the commonest infecting organism in encephalitis?
HSV-1
What brain lobe is most affected in HSV encephalitis?
Temporal lobe
What is the Mx of HSV encephalitis?
IV aciclovir
Gastroenteritis is mainly viral or bacterial?
Viral
Diarrhoea definition
3 loose stools in 24hr
What is the most important complication of gastroenteritis in children?
Dehydration
What are the components of the sepsis 6?
O2, fluids, ABx
BC, UO, lactate
What volume of fluid is given in a fluid bolus?
20ml/kg over 5 - 10 min
What scan is done first for recurrent UTIs in children?
US (then DMSA)
A UTI in children could present with loss of appetite, clinginess and lethargy - true or false
True
What is the 1st line Mx of pyelonephritis in a child?
IV amox + genta
What is the 1st line Mx of a lower UTI in a child?
PO trimethoprim or PO nitrofurantoin
What are the indications for tonsillectomy?
tonsillitis disabling, >7 in 1yr OR 2X 5 in 1yr
passmed says otherwise
What is the commonest organism in tonsillitis?
Strep pyogenes
What diagnostic criteria are used for tonsillitis?
CENTOR Age <15 Tonsillar exudate Fever No cough Tender cervical lymphadenopathy
When do you give antibiotics for tonsillitis? What is the antibiotic of choice?
If CENTOR >3
Pencillin V
What is the management of quinsy?
Needle aspiration OR incision / drainage
+ IV ABx
What is used as ABx therapy for close contacts of confirmed meningococcal disease?
Oral ciprofloxacin
What is the 1st and 2nd line ABx of choice in acute otitis media?
1st amox
2nd clarithromycin
What is seen on otoscopy in acute otitis media?
Air fluid level behind red tympanic membrane
Add infectious mononucleosis notes
Add it
Meningococcal sepsis is a contraindication to lumbar puncture - true or false
True (not to do with raised ICP - the coagulopathy in meningococal implies DIC - so LP would cause bleeding)
