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Paeds core conditions > Core conditions > Flashcards

Core conditions Flashcards

1
Q

Poor prognostic factors in constipation?

A
  1. Multiple relapses after initial Tx (esp in boys)
  2. <4 years
  3. Psychosocial/behavioural problems
  4. Encoparesis
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2
Q

Treatment for contipation? a) Long term and b) short term

A

a) Disimpaction with a macrogol (polythelene glycol-movicol). No improvement after two weeks add stim laxative (e.g. senna). Use behavioural strategies.

b) Short term/maitenance. Use osmotic laxative (macrogal or lactulose) preferrably.
Behavioural strategies.

Avoid long term use of stimulant laxatives. Can lead to electrolyte disturbances and atonic colon.

AVOID RECTAL TX IN PRIMARY CARE

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3
Q

Name of defective protein in CF? On which chromosome?

A

Cystic fibrosis transmembrane conductance regulator (CFTR). On chromosone 7.

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4
Q

Name of defect that causes infertility in males with CF?

A

obstructive azoospermia

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5
Q

How is CF definitively diagnosed?

A

A sweat test. Used to confirm that the concentration of chloride in sweat is markedly elevated (Cl 60 – 125 mmol/L in CF, 10-40 mmol/L in normal children).

  • Sweating is stimulated by pilocarpine iontophoresis.
  • The swear is collected into a special capillary tube or absorbed onto a weighed piece of filter paper.
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6
Q

GORD risk factors in kids?

A

Premature birth, parental history of regurg, obesity, hiatus hernia, history of congen diaphrag hernia repair, history of congen oesophgeal atresia repair, neurodisability

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7
Q

With GORD in infants, what treatment would you offer after behaviour modification, thickened formula and alginate therapy?

A

Try a PPI or H2RA if kids can’t tell you about symptoms or refusing feeds/FTT/distressed behaviour.

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8
Q

Complications of GORD in childhood?

A

Oesophageal stricture (dysphagia), faltering growth, anaemia, lower resp disease, barrets (metaplasia from squamous to columnar).

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9
Q

Normal fluid intake for kids 4-8 years old? (Males and females)

A

Males: 1000-1400ml
Females: 1000-1400ml

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10
Q

Should you use desmopressin in children who only have daytime wetting?

A

No

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11
Q

What are the first and second line treatments for bedwetting in children aged 5 and above?

A

Behavioural modification and if appropriate, the use of an alarm.

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12
Q

Side effects of desmopressin?

A

Nausea, mild tummy pain and headache. Serious: fluid overload. Don’t drink 1 hour before and 8 hours after taking it. No more than 240ml (1 cup of fluid).

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13
Q

When can antibiotics be given for whooping cough?

A

Within the first three weeks of onset of symptoms.

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14
Q

What does the FARMER mnemonic for squint examination stand for?

A

Fields-bring hands in, test for blind spot
Acuity-say how, age 4 do snellen tests
Reflexes: corneal light, pupillary light reflex (direct and consensual)
Movement+cover/uncover: H shape
Extra: paralytic squint: CT/MRI, investigate for brain lesion/raised ICP
Retina: red light reflex, fundoscopy, nose dilating drops needed but can interfere with neuro obs for 24 hours

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15
Q

How is mild and severe failure defined in relation to growth charts?

A

Mild=fall through 2 centiles

Severe=fall though 3 centiles

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16
Q

At what point should premature babies reach normal head circumference byʔ

A

18 months

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17
Q

At what ages is the onset or prolongation of neonatal jaundice worrying?

A

<24 hours or over 2 weeks. Or 10 days of jaundice.

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18
Q

What are the complications of phototherapy?

A

Away from mum, can get dehydrated (inc fluids) and loose stools. Also need to make sure to protect babies eyes.

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19
Q

What does hemiplegia in cerebral palsy mean?

A

Leg and arm of one side of the body is affected

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20
Q

What proportions of patients with cerebral palsy have LDs?

A

50%

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21
Q

Cerebral palsy risk factors?

A

Pre term birth, multiple pregnancy, maternal infections (rubella, toxoplasmosis, chickenpox), mother who smokes, drinks or takes blood, low birth weight, exposure to methyl mercury, meningitis/head injury as a baby, severe jaundice.

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22
Q 
Typical ages for the following milestones:
•	Sit unaided at ? months.
•	Crawl by ? months.
•	Pull to stand by ? months.
•	Walk by ? months.
A
  • Sit unaided at 6 months.
  • Crawl by 8 months.
  • Pull to stand by 12 months.
  • Walk by 15 months.
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23
Q

Name the common organisms in paediatric septic arthritis?

A

Staph aureus (most common in all age groups), Streptococci, H. influenza (especially before vaccinations introduced was usually multiple sites), Neisseria Gonorrhoea

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24
Q

When is type 1 diabetes most likely to present?

A

Aged 5-7 and just before puberty

25
Q

Which bloods should you do for suspected diabetes?

A

U&E, pH (exclude DKA), diabetes related auto-antibodies (islet cell antibody (ICA)/anti-insulin antibody (IAA)/Anti-GAD antibody (GAD), other autoimmune disease screen (thyroid, coeliac)

26
Q

What BM indicates hypoglycaemia?

A

<3.5 mmol/L

27
Q

What vaccinations are given at 3 months old?

A

DTP/IPV/Hib, rotavirus (oral), Men C

28
Q

Vaccinations given at 4 months old?

A

o DTP/IPV/Hib
o PCV
o Men B

(These are the same as the 2 month vaccinations, minus the rotavirus!)

29
Q

What ages is the men C vaccine given at?

A

3 months (12 weeks) and 1 year

30
Q

What ages is the men B vaccine given at?

A

2 months (8 weeks) and 4 months (16 weeks)

31
Q

Which vaccines are given at 1 year of age?

A

PCV, MMR, Men B, PCV, Hib/Men C booster

32
Q

Main viral pathogens that cause meningitis?

A

enterovirus, adenovirus, EBV and mumps (now rare).

33
Q

Neonatal bacterial pathogens that cause meningitis? (in babies <3 months)

A

B strep, E.coli (and other coliforms), listeria monocytogenes

34
Q

Initial blind therapy for children under 3 months of age with bacterial meningitis?

A

intravenous cefotaxime plus either amoxicillin or ampicillin. NB: ceftriaxone should not be used in premature babies or in babies with jaundice, hypoalbuminaemia or acidosis, as it may exacerbate hyperbilirubinaemia.

35
Q

Initial blind therapy for children over 3 months of age with bacterial meningitis?

A

Intravenous ceftriaxone. If calcium-containing infusions are required at the same time, cefotaxime is preferable.

36
Q

Symptoms of henoch schonlein purpura?

A

Purpuric rash (especially on buttocks, legs and around the elbows), pain in the joints, tummy pain

37
Q

Management of henoch schonlein purpura?

A

Usually self limiting (Tx does not reduce duration of symptoms), NSAIDs (be careful about renal issues).treated supportively. A variety of drugs (steroids, azathioprine, cyclophosphamide) and plasmapheresis have been used to prevent the progression of the renal disease.
Corticosteroids can ameliorate associated arthralgia and the symptoms associated with gastrointestinal dysfunction. There was no evidence of benefit of prednisone in preventing serious long-term kidney disease in HSP

38
Q

Management of henoch schonlein purpura?

A

Usually self limiting (Tx does not reduce duration of symptoms), NSAIDs (be careful about renal issues).treated supportively. A variety of drugs (steroids, azathioprine, cyclophosphamide) and plasmapheresis have been used to prevent the progression of the renal disease.
Corticosteroids can ameliorate associated arthralgia and the symptoms associated with gastrointestinal dysfunction.

39
Q

Name of the clinical scoring system for croup?

A

Westley score

40
Q

If a patient with croup has inspiratory stridor when agitated, mild intercostal recessions, normal air entry, no cyanosis and a normal conscious level, what is their westley score?

A

2

41
Q

What fluid bolus should be used for resus in paeds?

A

20 ml/kg sodium chloride 0.9% over 5–10 minutes. Assess and consider giving more.

42
Q

Contacts of children with septic shock should be given which antibiotic?

A

Rifampicin (turns wee pink!)

43
Q

What happens when asthmatics are exposed to triggers?

A
  • bronchoconstriction/airway narrowing

- mucosal oedema & excess mucus production

44
Q

Name two Long acting beta 2 agonists

A

salmeterol, formoterol

45
Q

What is step 2 in asthma management?

A

Short acting β2-bronchodilator as required +

Low-dose inhaled steroid (200-400micrograms/day)

46
Q

What is step 3 in asthma management?

A

Short acting β2-bronchodilator as required + high-dose inhaled steroid
OR
Low-dose inhaled steroid +/- long-acting bronchodilator
- If control is still inadequate use a trial of other therapies
e.g. leukotriene receptor antagonist or slow release theophylline

47
Q

Symptoms of bronchiolitis?

A

-Early Sx are of a viral URTI for 1-3 days followed by:
→persistent cough and
→either Tachypnoeic or chest recession (or both) and
→either wheeze or crackles on auscultation (or both)

Can have poor feeding, fever, infants have apnoea episodes

48
Q

Typical age for developing bronchiolitis?

A

Peak at 3-6 months and usually under 2 years old.

49
Q

Main symptoms of epiglottis?

A

history of fever, difficulty talking, irritability, drooling/swallowing issues (QUICK ONSET)

UNLIKE CROUP COUGH IS OFTEN ABSENT

50
Q

Management of epilglottitis

A

If acute epiglottitis, the child needs to be managed in the intensive care unit after endotracheal intubation.
Start IV Cephalasporin for 7-10 days
Give Rifampicin prophylaxis to close relatives.

51
Q

Most common causes of bacterial pneumonia in neonates?

A

Group B strep, E coli, Klebsiella, S. Aureus

52
Q

Most common causes of bacterial pneumonia in infants (not neonates)?

A

S pneumoniae and chlamydia pneumonia

53
Q

What is the first line antibiotic for childhood pneumonia?

A

Amoxicillin

54
Q

Alternative antibiotics for children allergic to penicillin with pneumonia?

A

Cefaclor, erythromycin, azithromycin, clarithroymcin (not pencillin allergic could also use co-amoxiclav)

NB first line=amox

55
Q

URTI: If group A strep grows on a swab which antibiotic do you prescribe?

A

Penicillin or erythromycin

56
Q

Abx for acute otitis media?

A

Co-Amoxiclav

57
Q

When do you do a CXR is a child presents with wheeze?

A
  • Does not have asthma
  • Never had a CXR before
  • GORD suspected
  • Foreign body inhalation
  • Monophonic wheeze (hilar LNs compressing R stem bronchus)
58
Q

Treatment of status epilepticus? (seizure activity lasting over 5 mins)

A

Buccal midazolam as first-line treatment in the community.
Rectal diazepam if preferred, or if buccal midazolam is not available.
Intravenous lorazepam if intravenous access is already established and resuscitation facilities are available.

59
Q

When do you call an ambulance for a child having a seizure?

A

Recurrent/prolonged, don’t respond to Tx, first ever seizure, there are difficulties managing the child’s condition

Paeds core conditions (1 decks)

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