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Year 4 Paeds > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Name four investigations if you suspected accidental poisoning in a child

A

Urine Dipsticks and Toxicology

Bloods (ABG, Drug Levels, Glucose, U&Es, LFTs, Coag, Drug levels)

ECG

XRays (Radio-Opaque tablets)

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2
Q

What do you want to know from the parents about the Accidental Poisoning?

A
  • Exact name of drug/chemical exposure
  • Preparation and Concentration
  • Probable dose as well as max possible dose
  • Time since ingestion/exposure
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3
Q

Name three overdoses that could cause respiratory depression

A

Antipsychotics
TCA
Alcohol

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4
Q

Name three overdoses causing VT

A

Amphetamines
Cocaine
Carbemazepine

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5
Q

Name three overdoses causing Miosis

A

Alcohol
Ketamine
Organophosphates

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6
Q

Name three overdoses causing Mydriasis

A

Atropine
Carbon Monoxide
TCAs

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7
Q

Name three overdoses causing Hypoglycaemia

A

Alcohol
Insulin
Propranolol

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8
Q

How is a Paracetamol overdose managed?

A

Children taking >150mg/kg need assessment

Take bloods after 4 hours and use nomogram

Acetylcystiene

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9
Q

What doses of Acetylcysteine are used in Paracetamol Overdose

A

IV load 150mg/kg
50mg/kg over four hours
100mg/kg over sixteen hours

Repeat at 24 hours

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10
Q

How is Anticholinergic/Antihistaminic overdose managed?

A

Benzodiazepines (if agitation and seizures)

Physostigmine (for Anticholinergic syndrome)

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11
Q

How is Benzodiazepine overdose managed?

A

If stable can just observe

Flumazenil (reverses lethargy and coma)

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12
Q

How is a Beta Blocker overdose managed?

A

Glucagon (reverses bradycardia and hypotension)

Cardiac pacing may be required

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13
Q

How is a CCB overdose managed?

A

Fluids and Ca2+

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14
Q

How is a Carbon Monoxide poisoning managed?

A

FiO2 1.0

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15
Q

How is Digoxin overdose managed?

A

Digibind

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16
Q

How is a Methanol overdose managed?

A

Fomepizole

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17
Q

How is a Narcotic overdose managed?

A

Naloxone

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18
Q

How is an Organophosphate overdose managed?

A

Atropine

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19
Q

When would you consider giving activated charcoal to a child in an accidental poisoning?

A

Presentation within one hour of ingestion

Substance is highly toxic and difficult to treat

Patient managing and protecting own airway

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20
Q

What is a child’s 24h fluid requirement?

A

100ml/kg for first 10kg of weight
+50ml/kg for second 10kg
+20ml/kg for remaining weight above 20kg

Sodium = 2-4mmol/kg
Potassium = 1-2 mol/kg
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21
Q

What must be examined in a child presenting with abdominal pain (in the case of referred pain)?

A

Testes
Hernial Orifices
Hip Joints

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22
Q

Give three surgical causes of Acute Abdo Pain

A

Acute appendicitis
Intestinal obstruction
Inguinal Hernias

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23
Q

Give three medical causes of Acute Abdo Pain

A

Gastroenteritis
HSP
DKA

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24
Q

Give three extra-abdominal causes of Acute Abdo Pain

A

URTI
Lower Lobe Pneumonia
Testicular Torsion

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25
Q

Define NSAP

A

Non Specific Abdominal Pain

Resolves in 24-48h
Less severe than appendicitis
Often accompanied by respiratory tract infection

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26
Q

How is Mesenteric Adenitis diagnosed?

A

Can’t be definitively diagnosed until large mesenteric nodes/normal appendix is seen on laparoscopy/laparotomy

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27
Q

Give four broad causes of Acute Joint Pain/Swelling.

A 
Monoarticular disease
Post Infectious Arthritis
Juvenile Arthritis and Spondyloarthropathies 
Non inflammatory 
Polyarticular disease
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28
Q

Name four causes of monoarticular disease

A

Septic Arthritis
Pigmented Villonodular Synovitis (synovium overgrows)
Sickle Cell
Leukaemia

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29
Q

What is the most common cause of Polyarthropathy?

A

Reactive Arthritis

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30
Q

Describe four diagnostic criteria for Juvenile Idiopathic Arthritis

A

Age of onset <16
Arthritis in >1 joint
Duration >6 weeks
Other conditions excluded

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31
Q

What are the different types of JIA?

A 
Systemic
Polyarticular
Oligoarticular
Rheumatoid positive
Rheumatoid negative
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32
Q

JIA is a clinical diagnosis, how could it be investigated?

A

Bloods (ANA +be associated with increased risk of eye disease)
USS (Arthritis, Tenosynovitis, Joint Damage)
Opthalmology clinic within 6 weeks

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33
Q

How is JIA managed?

A

Treat acute joints as required

Promote physical activity

Methotrexate

Uveitis screening and management every 6m

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34
Q

How are acutely painful joints managed?

A

NSAIDs for two weeks while awaiting paeds review
Intra-articular steroids (if disability and joint restriction)
PO/IV steroids if many joints involved

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35
Q

What is the normal crying pattern of a baby?

A

Atleast two hours a day for first six weeks

70% between noon and midnight

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36
Q

Give five potential causes of a crying baby

A 
Normal
Colic
CMPA
GOR
Torted Testicle
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37
Q

Give four red flags for a crying baby

A

Fever
Bilious vomiting
Sudden change in behaviour

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38
Q

Why should you check genitalia and digits in a crying baby?

A

In case of a hair tourniquet

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39
Q

What is an important question to ask the parents of a crying baby?

A

Do you feel you might harm the baby?

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40
Q

How should a crying baby be managed?

A

Reassure parents
Check their simple needs
Feeding
5S’s

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41
Q

What are the 5 S’s?

A 
Sling
Sucking
Swaddling
Shushing
Swinging
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42
Q

Define Decreased Consciousness

A

Responsive only to voice or pain, or totally unresponsive (in regards to AVPU) OR GCS<14

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43
Q

What is the exclusion criteria for decreased consciousness?

A

Infants in NICU
Known conditions of reduced consciousness (epilepsy, diabetes)
Learning disabilities whose baseline is <15

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44
Q

What investigations could you do in a patient with decreased consciousness?

A 
CBG
Urine Dipstick
Blood Glucose
Plasma Ammonia 
FBC
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45
Q

What is required to diagnose Shock?

A

> 1 of

Cap Refill>2 
Mottled and cold
Reduced peripheral pulses
Systolic BP less than 5th centile
UO <1ml/kg/h
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46
Q

How is Shock managed?

A

20ml/kg IV bolus

Can be repeated once

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47
Q

Give four typical features of a Septic Child

A

Temp>38 or <36
Tachycardia
Tachypnoea
Non Blanching Rash

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48
Q

When should Hypoglycaemia be diagnosed as the cause of reduced consciousness in a child?

A

Capillary glucose <2.6 mmol/l

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49
Q

How should Hypoglycaemia be managed?

A

<4 weeks - 2ml/kg IV 10% Glucose bolus
>4 weeks - 5ml/kg IV 10% Glucose bolus

10% glucose IV infusion

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50
Q

When should Hyperammonaemia be diagnosed as the cause of reduced consciousness in a child?

A

Plasma ammonium >200 micromol/l

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51
Q

How should Hyperammonaemia be managed?

A

IV Sodium Benzoate

Check amino acids and organic acids

If refractory - consider haemodialysis

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52
Q

When should raised ICP be considered to be diagnosed as the cause of reduced consciousness in a child?

A

Abnormal respiratory pattern
Abnormal pupils
Abnormal posture

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53
Q

How is raised ICP managed?

A

Tilt head up to 20 degrees

No Hypotonic Maintenance fluids

Mannitol

Intubation

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54
Q

How should you manage reduced consciousness if cause is unknown?

A

Supportive

Broad Spectrum Abx and IV Aciclovir

Discuss with paediatric neurologist

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55
Q

A seriously unwell child should always be approached using A to E first. How should airways be assessed?

A

Neutral head position in infants

Sniffing position in child

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56
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child less than one?

A

30-40

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57
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged 1-2?

A

25-35

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58
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged 2-5?

A

20-30

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59
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged 5-12?

A

15-25

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60
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of resp rates in a child aged >12?

A

12-20

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61
Q

Resp Rate is an indication of Breathing Effort. What are the other two aspects?

A

Efficacy - chest expansion and auscultation

Effect - Drowsiness, Agitation

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62
Q

A seriously unwell child should always be approached using A to E first. What is a Decorticate posture?

A

Flexed arms, extended legs

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63
Q

A seriously unwell child should always be approached using A to E first. What is a Decerebrate posture?

A

Extended arms and legs

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64
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 0-3 months?

A

100-150

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65
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 3-6 months?

A

90-120

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66
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 6-12 months?

A

80-120

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67
Q

A seriously unwell child should always be approached using A to E first. What are the normal ranges of pulse rates in a child aged 1-10 years?

A

70-130

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68
Q

What is a Secondary Assessment of a child?

A

Reassess the response to initial measures
Take a focussed history
Detailed examinations
Further investigations

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69
Q

If when assessing airways and breathing in an acutely unwell child you heard bubbling what would be your diagnosis and management?

A

Excess Secretions

Suctioning

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70
Q

If when assessing airways and breathing in an acutely unwell child you heard harsh Stridor/barking cough what would be your diagnosis and management?

A

Croup

Oral Dexamethasone, Nebulised Budesonide, Adrenaline

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71
Q

If when assessing airways and breathing in an acutely unwell child you heard Soft Stridor/the child was drooling what would be your diagnosis and management?

A

Epiglottitis/Bacterial Tracheitis

Intubation and IV Abx

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72
Q

If when assessing airways and breathing in an acutely unwell child you heard sudden Stridor what would be your diagnosis and management?

A

Foreign body aspiration

Laryngoscopy and removal

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73
Q

If when assessing airways and breathing in an acutely unwell child you heard Stridor after allergen exposure what would be your diagnosis and management?

A

Anaphylaxis

IM adrenaline, IV Hydrocortisone, IV Chloramphenamine

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74
Q

If when assessing airways and breathing in an acutely unwell child you heard a wheeze what would be your diagnosis and management?

A

Acute Asthma

Bronchodilators

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75
Q

If when assessing airways and breathing in an acutely unwell child you heard Bronchial Breathing what would be your diagnosis and management?

A

Pneumonia

IV Abx

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76
Q

PDA Closure in infants with CHD May appear similar to sepsis/IEM. Give four clinical features and the management.

A

Poor Feeding
Sleepiness
Slightly fast breathing
Collapsed in cardiogenic shock

IV Dinopristone

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77
Q

If when assessing Circulation in an acutely unwell child you discovered an SVT what would be your management?

A

Vagal manouvres initially

IV Adenosine/DC Shock

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78
Q

Give two common causes of a limp in a child <3y

A

Fracture/Soft Tissue Injury

DDH

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79
Q

What are you concerned about with sprains in children?

A

Injury to growth plate

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80
Q

What is a Toddler’s Fracture?

A

Subtle undisplaced spiral fracture

Often caused by sudden twist

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81
Q

Give three causes of a limp in a child aged 3-10y

A

Transient Synovitis
Fracture/Soft Tissue Injury
Perthes

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82
Q

Give five causes of a limp in a child aged 10-19

A 
SCFE
Perthes
Osgood Schlatter
Sever’s Disease
Chondromalacia Patellae
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83
Q

Name two haematological conditions that can cause joint pain

A

Sickle Cell

Haemophilias

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84
Q

How is children’s pGALS different to adults?

A

Further assessment of foot and ankle
Assessment of TMJ
Assessment of Elbow
Assessment of Cervical Spine

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85
Q

Name three screening questions in pGALS

A

Any pain/stiffness
Any difficulty getting dressed
Any problems with stairs

86
Q

What specific gaits are you observing for in pGALS?

A

Trendelenberg
Waddling
Tip Toe

87
Q

Give three red flags in an Acute Limp

A

Night time pain
Redness and swelling
Palpable mass

88
Q

What is the most likely diagnosis of an acute limp in under 3s and over 9s respectively?

A

Septic Arthritis

SCFE

89
Q

Define ALTE (AKA BRUE - Brief Unresolved Unexplained Event)

A

An episode that is frightening to the observer during which a combination of apnoea/choking/gagging/colour change are reported. Lasts less than one minute and resolves spontaneously

90
Q

50% of causes of BRUE remain unknown. Describe four possible.

A

GORD
Seizures
OSA
CHD

91
Q

Name two risk factors for BRUEs

A

Infants less than two months old

If less than 30d it’s more likely to be serious or repeated

92
Q

How would you investigate a low risk child who has had a BRUE?

A

ECG

Perinasal swab for Pertussis

93
Q

How would you investigate a high risk child who has had a BRUE?

A 
ECG
Perinasal swab
CXR
Blood Gas
Bloods
94
Q

How would you manage a BRUE?

A

Reassure parents
Observe for a period of time

Low risk - safety net, offer BLS training
High risk - Paeds admission and overnight sats monitoring

95
Q

Give three indications for a head CT in Head and Neck trauma

A

GCS<12
LOC
Neurological Signs

96
Q

Why are children more at risk of internal damage in trauma?

A

Elasticity of children’s ribs reduces risk of fractures but allows transfer of energy to internal structures

97
Q

What is the definitive management for severe trauma?

A

Transferred to PICU

Significant head injuries -> regional neurosurgical unit (haematoma evacuated within 4h)

98
Q

Define Bell’s Palsy

A

Acute paralysis of muscles of facial expression (may be unable to close eye on affected side)

99
Q

Describe the pathophysiology of Bells Palsy

A

Normally unilateral but can be a bilateral LMN lesion, secondary to oedema as it passes through temporal bone

Can be Idiopathic, Viral, or due to Lyme Disease

100
Q

How should you examine a patient with Bells Palsy?

A

Check the other functions of facial nerve (impaired taste, hyperacusis)
Full neuro examination

101
Q

Name two differentials for Bells Palsy

A

Compressive lesion in Cerebellopontine angle (all functions of facial nerve affected)

Painful vesicles on tonsillar region and external ear - Herpes Virus

102
Q

How is Bells Palsy managed?

A

PO Prednisolone for 5d if within first week of presentation
IV Aciclovir (if Varicella)
Lubricating eye drops (to prevent conjunctival infection)

103
Q

What are the reversible causes of Cardiac Arrest (4Hs and 4Ts)?

A

Hypoxia, Hypovolaemia, Hypothermia, Hyperkalaemia

Tamponade, Thrombosis, Toxins, Tension Pneumothorax

104
Q

Describe the BLS of a child

A

1) 5 rescue breathes
2) Check brachial pulse
3) 15 compressions: 2 rescue breaths

Be can refill not to hyperventilate (reduces venous return and eventually perfusion)

105
Q

Describe the ALS management of shockable rhythms (VF, pVT)

A

4J/Kg shock every 2 minute cycle

After 3rd shock give Adrenaline 10 micro gram/kg and Amioderone 5mg/kg

Give adrenaline on alternating cycles

106
Q

Describe the ALS management of non shockable rhythms (PEA, Asystole)

A

CPR

IV 10microgram/kg Adrenaline every 3-5 minutes

107
Q

Give 6 causes of Dehydration

A 
GI - Gastroenteritis
Oropharyngeal - Tonsillitis
Endocrine - DKA
Inadequate Intake - Tongue Tie
Increased Output - Burns
Other - Febrile Illness
108
Q

What would you see clinically at 5% dehydration?

A

Abnormal Cap Refill
Abnormal Skin Turgor
Abnormal Resp Pattern

109
Q

State three symptoms of mild to moderate dehydration

A

Restlessness
Sunken Eyes
Thirst

110
Q

State three symptoms of severe dehydration

A

Lethargic
Poor Drinking
Rapid Pulse

111
Q

How can skin turgor be used to indicate Dehydration?

A

Normal - skin retracts immediate
Mild to Mod - Slow, Skin retracts in <2 seconds
Severe - skin fold retracts in >2 seconds

112
Q

Give three red flags of dehydration

A

Altered responsiveness
Tachypnoea
Tachycardia

113
Q

What investigations should be carried out on a dehydrated patient?

A

Urine tests (Ketones, Glucose, Specific Gravity)
Bloods (U and Es, Glucose)
ECG

114
Q

How is Mild to Moderate dehydration treated?

A

IV therapy not required as long as oral fluids are tolerated

Dioralyte or Breast Milk

115
Q

When would you rehydrate a patient with IV fluids in dehydration? What do you have to consider?

A

If shock is suspected
Red flags despite oral fluids
Persistent vomiting of Oral Fluids

Sodium levels

116
Q

Intraosseous fluid rescucitation is given if venous access is impossible due to circulatory collapse. Where is the preferred insertion point?

A

Proximal Tibia

117
Q

How do you calculate a fluid deficit?

A

Weight x %dehydrated x 10ml

118
Q

How can you monitor a dehydrated child’s response to fluids?

A 
General well-being
Fontanelle tension
Capillary Refill
BP
Urine Output
119
Q

What is the normal urinary output of different age groups?

A

<1yr - 2ml/kg/h
Toddler - 1.5ml/kg/h
Older - 1ml/kg/h
Adult - 0.5ml/kg/h

120
Q

Describe the epidemiology of Epistaxis

A

Bimodal - Children (naturally narrow airways, nose picking) and Elderly (Anticoagulant therapy)

Under 2 is very rare and should be referred to ENT

121
Q

Describe the pathophysiology of Epistaxis

A

Usually in Littles Area

Caused by trauma, mucosal irritation, clotting disorders

122
Q

What vessels coalesce in Littles Area?

A

Internal Carotid (Anterior Ethmoidal, Posterior Ethmoidal)

External Carotid (Sphenopalantine, Greaater Palantine, Superior Labial)

(5)

123
Q

What should be a consideration in children with epistaxis?

A

Foreign Body

If unilateral offensive discharge mixed with blood

124
Q

Epistaxis is a clinical diagnosis (unless recurrent or large volumes). Describe the first aid management.

A

Lean child forward and punch soft part of nose for >15 minutes

After 15 minutes check for cessation

If not then hold again and put ice pack on back of neck

125
Q

How is Epistaxis managed in primary care?

A

Local anaesthetic to septum

Cautery with silver nitrate

If continuing - ENT will place packing

126
Q

What would you advise the patient with Epistaxis on discharge?

A

Naseptin Ointment BD for 2 weeks

Avoid: Strenuous activity, bending forwards, hot drinks

127
Q

Define Febrile Convulsions

A

Seizure accompanied by fever (>38) without CNS infection, occurring between 6m -5y

128
Q

What are the three types of Febrile Convulsions?

A

Simple - Generalised tonic Clonic, <15 mins

Complex - partial, >15 mins, recurrent within 24

Status Epilepticus - >30 minutes, no full recovery

129
Q

The cause of Febrile Seizures is relatively unknown. What are some potential causes

A

Family History (in 24%)
Viral Infections
Otitis Media
Post Immunisaton

130
Q

One of the main differentials for Febrile Convulsions if Reflex Anoxic Seizures. What is this?

A 
A precipitant (such as minor bump) causes a vagally mediated asystole
Child becomes floppy then tonic Clonic seizures
131
Q

What differentials are important to rule out with Febrile Convulsions?

A

Meningitis

Sepsis

132
Q

How would you investigate Febrile Convulsions?

A

Bloods (FBC, ESR, Glucose, UEs, Coag, Culture)

Urine Microscopy and Culture (<18m or complex)

LP

133
Q

Usually a child with Febrile convulsions can be managed at home. What should you advice the parents?

A

What febrile seizures are

How to treat the fever at home

What to do if the child has a fit (recovery position)

Seizure>5 minutes call 999

134
Q

Hypothermia is a temperature <36 degrees and is normally caused by immersion or excess exposure. Give two reasons why children are predisposed

A

Large SA/V

Thermoregulatory response altered

135
Q

Give four presenting features of Hypothemia

A

Body shivers
Numb extremities
Lack of coordination
Mental confusion

136
Q

How can you prevent Hypothermia in a child?

A

Dry skin
Cover head
Minimise exposure in examinations
Avoid cold fluids

137
Q

What are the rewarming strategies for children?

A

Gastric or bladder lavage with 42 degrees saline

Dialysis warming

138
Q

Name 8 different types of Hyperthermia

A 
Heat Stress
Heat Fatigue
Heat Syncope
Heat Cramps
Heat Oedema
Heat Rash
Heat Exhaustion 
Heat Stroke
139
Q

What is Heat Stress?

A

If temperature climbs and you’re unable to cool yourself by sweating
Mx - get to a cool area and drink water

140
Q

What is Heat Stroke?

A

Body temperature above 40 degrees

Fainting is often the first sign

Cool bath and ice bags under arms and groin

141
Q

What is Heat Syncope?

A

Reduced blood pressure after exertion

Cool down and place legs in air, rehydrate

142
Q

What are Heat Cramps?

A

Secondary to electrolyte imbalance

143
Q

What is Heat Oedema?

A

Thought to be due to reduced RAAS action leading to fluid build up in extremities

144
Q

Why is Hyperthermia not the same as fever?

A

Hyperthermia is responding to external changes rather than infection

145
Q

Define Hypogylcaemia

A

Blood value <3 if symptomatic, or <2.6 if asymptomatic

146
Q

Name three endocrine causes of hypoglycaemia

A

GH Deficiency
CAH
Hypopituitarism

147
Q

Name two metabolic causes of hypoglycaemia

A

Glycogen storage disease

Galactosaemia

148
Q

Name three toxic causes of hypoglycaemia

A

Alcohol
Salicyclates
Insulin

149
Q

Name three hepatic causes of hypoglycaemia

A

Hepatitis
Cirrhosis
Reyes Syndrome

150
Q

Name three neonatal causes of hypoglycaemia

A

Poor maternal nutrition
Poorly controlled maternal diabetes
HDN

151
Q

What are you looking for OE in a hypoglycaemic child?

A

Short stature
Failure to thrive
Hepatomegaly

Symptoms in relation to feeding

152
Q

How would you manage Hypoglycaemia?

A

Asymptomatic - PO Glucose/Gel

Symptomatic - 2ml/kg 10% Dextrose IV, followed by continuous infusion

No response - Glucose, Hydrocortisone

153
Q

Malnutrition is a common cause of child mortality. How does Iron Deficiency present?

A

Microcytic hypochromic anaemia
Koilonychia
Fatigue
Angular stomatitis

154
Q

Malnutrition is a common cause of child mortality. How is Iron Deficiency treated?

A

PO 4-6mg/kg Iron daily

155
Q

Malnutrition is a common cause of child mortality. How does Vitamin A Deficiency present?

A

Usually associated with fat malabsorption states
Xerophthalmia
Night Blindness
Follicular Hyperkeratosis

156
Q

Malnutrition is a common cause of child mortality. How does Vitamin D Deficiency present?

A

Rickets

157
Q

Malnutrition is a common cause of child mortality. How is Vitamin D Deficiency managed?

A

Vitamin D
Calcium
Phosphate

158
Q

Give three causes of Vitamin K deficiency

A

Congenital
Fat malabsorption
Small bowel bacterial overgrowth

159
Q

Malnutrition is a common cause of child mortality. How does Vitamin K Deficiency present?

A

Bleeding

160
Q

Malnutrition is a common cause of child mortality. How is Vitamin K deficiency managed?

A

IV 1mg Vitamin K

161
Q

What is the main cause of Vitamin B1 deficiency?

A

Dietary deficiency - eg rice diet

162
Q

Malnutrition is a common cause of child mortality. How does Vitamin B12 deficiency present?

A

Megaloblastic anaemia
Peripheral Neuropathy
Motor weakness

163
Q

Malnutrition is a common cause of child mortality. How is Vitamin B12 deficiency managed?

A

1mg IM Vit B12 every 1-3 months

164
Q

How does Scurvy present?

A

Petichiae
Ecchymoses
Bleeding gums
Motor weakness

165
Q

How is Scurvy managed?

A

PO Vitamin C QDS for four days, then BD

166
Q

Malnutrition is a common cause of child mortality. How does Vitamin E deficiency present?

A

Haemolytic Anaemia

Visual impairment

167
Q

Malnutrition is a common cause of child mortality. How does Folic Acid deficiency present?

A

Megaloblastic anaemia
Thrombocytopenia
Irritability

168
Q

Give three causes of folate deficiency

A

Small bowel disease
Malignancy
Anticonvulsants

169
Q

Give three causes of Zinc deficiency

A

Prematurity
Chronic Diarrhoea
Acrodermatitis Enteropathic (genetic error)

170
Q

Malnutrition is a common cause of child mortality. How does Zinc Deficiency present?

A

Periorofacial and Anal dermatitis
Diarrhoea
Alopecia

171
Q

How should you examine a child with suspected Protein Energy Malnutrition?

A

Examine mid arm circumference rather than weight due to oedema

172
Q

What is Kwashiorkor?

A

Severe deficiency of protein/amino acids leading to growth retardation, diarrhoea, oedema and abdominal distension

173
Q

What would investigations occur Kwashiorkor show?

A

Low albumin
Low Calcium, magnesium, phosphate
Low glucose
Low Hb

174
Q

What is Marasmus?

A

Severe calorie deficiency with preserved height, low weight and wasted appearance

175
Q

How do you managed Protein Energy Malnutrition?

A

Correct dehydration and electrolyte imbalance

Treat underlying infections

Treat specific nutritional deficiencies

Slow oral refeed

176
Q

Why do Paediatric patients fare better in Paracetamol overdose?

A

Better ability to conjugate with surface
Enhanced NAPQI detoxification
Greater Glutathione stores

177
Q

How would you manage Paracetamol overdose?

A

Activated charcoal if within one hour

N-Acety Cystiene over 3 infusions (same as adult doses but less fluid to compensate)

178
Q

What is Erb’s Palsy?

A

Damage to the upper brachial plexus (ie 5th and 6th cranial nerves)

179
Q

Name three risk factors for Erbs Palsy

A

Macrosomia
Maternal propulsive forces
Excess shoulder traction in labour

180
Q

How does Erbs Palsy present?

A

Waiters tip

Adducted, pronated and internally rotated

Absent biceps reflex

181
Q

How is Erbs palsy managed?

A

Intermittent immobilisation and positioning to prevent contractures

Physiotherapy

Electrical stimulation

Referral to neurosurgeon if persisting >3m

182
Q

What is Klumpke’s Paralysis?

A

Much less common than Erbs

Due to damage of C7,C8 and T1

183
Q

How does Klumpkes palsy present?

A

Hand weakness
Loss of grasp
Horners Syndrome if T1 affected

184
Q

How is Klumpkes palsy managed?

A

Same as Erbs

185
Q

What can cause radial nerve palsies in children?

A

Dislocation of Humoral head
Humoral shaft fractures
Radial bone fractures
Injections in small babies

186
Q

How does Radial a Nerve Palsy present?

A

Above elbow - everything drops
At elbow - wrist drop and unable to supinate
Below elbow - wrist drop

187
Q

How is radial nerve palsy investigated?

A

Nerve conduction studies

USS

188
Q

How is a radial nerve palsy managed?

A

If it is due to a fracture it normally resolves spontaneously
Splints
Anti inflammatories

189
Q

Name two causes of Ulnar Nerve palsies in children

A

Elbow dislocation

Poorly healed supracondylar fractures

190
Q

How do Ulnar Nerve palsies present?

A

Ulnar Claw

Less pronounced the higher the lesion due to FDP paralysis (Ulnar Paradox)

191
Q

How are Ulnar Nerve Palsies managed?

A

NSAIDs and wait

Surgery if not treated

192
Q

Give three causes of Median Nerve Palsy in children

A

Wrist trauma
Post Colles
Ganglions

193
Q

How do Median Nerve Palsies present?

A

Weak pronation
Weak wrist flexion
Thenar atrophy

194
Q

Give two causes of Olfactory nerve damage

A

Trauma

Meningitis

195
Q

Give a cause of monocular and bilateral optic nerve damage

A

Monocular - MS

Bilateral - Raised ICP

196
Q

Give a cause of Oculomotor nerve damage

A

Raised ICP

197
Q

How does Oculomotor nerve damage present?

A

Fixed dilated pupil that won’t accommodate

Then ptosis

198
Q

How does CNIV nerve damage present?

A

‘Down and Out’

199
Q

Give a cause of Trigeminal Nerve palsy. How would it present?

A

Bulbar Palsy

Reduced sensation and jaw clenching

200
Q

Give three causes of Facial Nerve Palsy

A

Bells Palsy
Otitis Media
Lyme Disease

201
Q

Give two causes of Vestibulocochlear nerve damage

A

Loud Noises

Pagets Disease

202
Q

Give two causes of femoral nerve damage in children

A

Post Breech

Hip fracture

203
Q

How do Femoral Nerve palsies present?

A

Buckling knees (eg on stairs)
Numbness of medial thigh and calf
Quadriceps wasting

204
Q

How is Femoral Nerve Palsy managed?

A

Exercises
Knee Bracing
Percutaneous nerve stimulation

205
Q

Give one cause of sciatic nerve damage in infants (rare in developed countries)

A

Gluteal injections

206
Q

How does Sciatic nerve damage present?

A

Lower limb pain
Foot drop
Abnormal gait

207
Q

Name three causes of Respiratory Arrest

A

Airway Obstruction
Decreased Respiratory Effort
Muscular weakness

208
Q

When is a patient at risk of respiratory muscle fatigue?

A

If breathing at a rate exceeding 70% of maximum ventilation for an extended time

209
Q

Name three causes of upper airway obstruction

A

Tongue displacing in oropharynx
Foreign Body
Mucous

210
Q

Give three causes of lower airway obstruction

A

Aspiration
Bronchospasm
Drowning

211
Q

What is the Paediatric Maintenance fluid of choice?

A

0.9% Sodium Chloride + 5% Glucose

Year 4 Paeds (15 decks)

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