Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th Year Paeds > Essential Conditions (1) > Flashcards

Essential Conditions (1) Flashcards

1
Q

Causes of neonatal jaundice <24 hours?

A

Haemolytic disorders (Rh/ABO incompatibility, G6PD deficiency, pyruvate kinase deficiency)

Congenital infection - sepsis (GBS, rubella)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of neonatal jaundice 24h - 2 weeks?

A 
Congential infection
physiological jaundice
breast milk jaundice, dehydration
infection (UTI)
haemolytic disorder
bruising
polycythaemia
Crigler-Najjar syndrome (rare – absence or deficiency or glucuronyl transferase).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of unconjugated jaundice >2 weeks?

A 
Physiological/breastmilk jaundcie
Infection (UTI)
Congenital hypothyoridism
Haemolytic anaemia
High GI obstruction (pyloric stenosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of conjugated jaundice >2 weeks?

A

Pale stools/dark urine, hepatomegaly and poor weight gain

Bile duct obstruction (biliary atresia)
Neonatal hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Test for whether bilirubin is conjugated or not?

A

Bilirubin fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is coombes test?

A

Direct antiglobulin test, tests agglutination of RBCs. Positive test in the presence of hyperbilirubinemia suggests a haemolytic jaundice.

Direct Coombes test – used to test for autoimmune haemolytic anaemia

Indirect Coombes test – prenatal testing of women, and testing blood prior to blood transfusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of neonatal jaundice?

A

Plot on treatment threshold chart - according to gestation

Phototherapy
Exchange transfusion

IV immunoglobulin if haemolytic disease or ABO incompatibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are live vaccines?

A 
BCG
MMR
Oral polio
Yellow fever
Oral typhoid
Intranasal flu
Rotavirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does the MMR contain egg?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Contraindications to vaccination?

A

Anaphylaxis/egg anaphylaxis

Immunosuppression - primary, pregnancy, immunosuppressive therapy (steroids, chemo) –> NO LIVE VACCINES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Consequences of measles mumps and rubella?

A

Measles - SSPE, death
Mumps - infertility
Rubella - pregnancy consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors for meningitis?

A

Impaired immunity - young age, splenic defects, defects of complement

Low SE status - crowding, poverty, close contact with affected individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of viral meningitis?

A

Parvovirus (ok), HSV (bad)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Presentation of meningitis in neonates?

A 
Fever no focus
Irritability
Seizures
Poor feeding
Respiratory distress
Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bacterial causes of meningitis in neonates - 3 months?

A

GBS
E.coli and other coliforms
Listeria monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bacterial causes of meningitis in 1 month - 6 years?

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bacterial causes of meningitis in >4 years?

A

Neisseria meningitidis

Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Brudzinski’s sign?

A

Flexion of neck with the child supine causes flexion of knees and hips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Kernig’s sign?

A

Child lying supine with hips and knees flexed, back pain on extension of knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is in a septic screen?

A 
Cultures
Urine
CXR
LP
Bloods - FBC, CRP, glucose, U+E

MC+S - bloods, stool, throat and urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contraindications of LP?

A

Focal neurological signs (seizures)
Raised ICP (low HR, high BP, papilloedema)
Shock/CV instability

RISK OF CONING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you do with LP sample?

A

M,C + S and PCR (amplifies sample)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bacterial meningitis on LP?

A

Turbid
Neutrophils (polymorphs) raised
Protein raised
Glucose low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Viral meningitis on LP?

A

Clear
Lymphocytes raised
Protein normal/raised
Glucose normal/low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TB meningitis on LP?

A

Turbid/clear/viscous
Lymphocytes raised
Protein very raised
Glucose very low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Managmenent of meningitis?

A

IMMEDIATE administration of abx and supportive therapy

ABCDE approach - may need boluses for shock

< 3 months = IV cefotaxime + amoxicillin (listeria cover)
>3 months = IV ceftriaxone

Supportive therapy = corticosteroids (not < 3 months), analgesics, antipyretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Prophylaxis in meningitis?

A

Rifampicin for household contacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Complications of meningitis (immediate)?

A

Septic shock
Seizures
DIC
Cerebral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Complications of meningitis (late)?

A

Hearing loss
Cerebral palsy (< 2 years)
Epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is purpura? What does it indicate?

A

Purplish discoloration of skin produced by small bleeding vessels near the surface.

Indicates a problem with platelet system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are petechiae?

A

Purpura spots that are very small (<1 cm in diameter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are ecchymoses?

A

Larger and deeper purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Differentials for purpuric rash?

A 
Meningococcal septicaemia
HSP
Immune thrombocytopenia
DIC
Lukaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is HSP?

A

IgA medicated vasculitis - non-thrombocytopenic purpura.

Lesions confined to buttocks, extensor surfaces of legs (and arms), along with abdominal pain and haematuria.

Child is usually systemically well.

May have haematuria and need to check urine sample with HSP as potential effects on kidney.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is ITP?

A

Auto-antibody (IgG) formation to platelets - IIb/IIIa glycoprotein.

Children aged 2-10 years
Presents 1-3 weeks after viral infection
Usually self-limiting within 6-8 weeks

WBC should be normal

36
Q

What is DIC?

A

Coagulation pathway activation –> fibrin deposition in the microvasculature and consumption of coagulation factors and platelets –> thrombocytopenic purpura.

Causes = severe sepsis and extensive damage from trauma or burns.

Presentation = bruising, purpura and haemorrhage.

Investigations = Thrombocytopenia, ↑PTT, prolonged APTT, ↓fibrinogen (correlates most closely with severity).

FFP + platelet transfusion

37
Q

Features of leukaemia?

A

Clinical features = Malaise, recurrent infections, bruising, petechiae, hepatosplenomegaly, lymphadenopathy.

Bloods = Thrombocytopenia, ↑WCC, ↓Hb

38
Q

Pathophysiology of sepsis?

A

Shock = Host response includes release of inflammatory cytokines and activation of endothelial cells –> septic shock.

Hypovolaemia = Occurs due to release of vasoactive mediators by host inflammatory and endothelial cells.
Endothelial dysfunction leads to capillary leak –> loss of intravascular proteins and fluid.
Leads to sepsis syndrome and DIC –> distributive and cardiogenic shock.

39
Q

Normal Hb levels at different ages?

A

Neonate = <140 g/L
1-12 months = <100 g/L
1-13 years = <110 g/L

40
Q

Causes of anaemia in infants?

A 
Impaired red cell production
Increased red cell destruction (haemolysis)
Blood loss (uncommon)
41
Q

Causes of anaemia if reticulocytes low?

A

Red cell aplasia

Parvovirus B19
Diamond-Blackfan anaemia

42
Q

Causes of anaemia if reticulocytes high or normal?

A

High bilirubin –> haemolysis = sickle cell, thalassaemia, hereditary spherocytosis

Normal bilirubin = iron deficiency

43
Q

Causes of iron deficiency?

A

 Inadequate intake – common in infants because additional iron required for increase in blood volume that accompanies growth and to build up child’s iron stores.
 Malabsorption
 Blood loss

44
Q

Sources of iron?

A

 Breast milk (low iron content but 50% of iron absorbed).
 Instant formula (supplemented with adequate amounts of iron.
 Cow’s milk (higher iron content than breast but only 10% absorbed) – shouldn’t give to infants.
 Solids at weaning (e.g. cereals are supplemented but only 1% absorbed).

45
Q

What increases iron absorption?

A

Vitamin C

46
Q

Investigations in IDA?

A

FBC -↓Hb, ↓MCV and MCH (mean cell Hb = average mass of Hb per RBC), ↓MCHC

Blood film - Microcytic, hypochromic anaemia

Serum ferritin - Low (poor iron stores)

47
Q

Management of IDA?

A

Dietary advice and supplementation with oral iron for several months.

Sytron or Niferex = good oral iron preparations as they do not stain teeth.

Should be continued until Hb is normal and then for a minimum of a further 3 months to replenish iron stores

48
Q

Features of life threatening asthma attack?

A

PEFR < 33%
Sats < 92%

Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia
49
Q

Max nebs of salbutamol and ipratropium?

A 
Salbutamol = hourly
IB = 4 hourly
50
Q

Dose of ipratoprium in acute asthma?

A

250 mcg

51
Q

What is the course of bronchiolitis?

A

3 day prodrome with ‘cold’ and harsh cough

3 day ill with fever, high-pitched wheeze and breathlessness

3 day recovering

52
Q

Risk factors for bronchiolitis?

A

Chronic lung diseases (e.g. CF)
Immunosuppressed (e.g. HIV)
Premature or ex-premature infants
Congential cardiac conditions

53
Q

Cause of bronchiolitis? Who does it present in?

A

RSV

Under 1 year

54
Q

Examination findings in bronchiolitis?

A

Sharp dry cough
Resp distress
Low grade fever
Tachycardia

FINE END INSPIRATORY CRACKLES
HIGH PITCHED WHEEZE

55
Q

Management of bronchiolitis?

A

Supportive

Oxygen - Via nasal cannula (2l max – hydrated to not dry out mucosa) Aim for >92%

Monitor for apnoea

Fluids - May need to be given via NGT or IV

Assisted ventilation - CPAP or Full ventilation in a small % of infants admitted.

56
Q

Prevention of bronchiolitis?

A

Palvizumab = monocloncal antibody to RSV. Given to:

o Premature babies
o Chronic lung disease
o Congential heart disease
o Cystic fibrosis

Monthly injection for 5 months starting in October. Appears to make illness less severe.

57
Q

What causes croup?

A

Viral croup = 95%
 Parainfluenza
 RSV/adenovirus/influenza

Bacterial tracheitis = Pseudomembranous croup
 Similar to viral croup but child has high fever, appears toxic and has rapidly progressive airways obstruction.
 Staph Aureus –> IV Abx

58
Q

Features of epiglottitis?

A
  • Prodrome: coryza
  • Barking cough (seal cough)
  • Harsh stridor
  • Hoarseness of voice
59
Q

Difference between croup and epiglottitis?

A

Croup = common

Drooling saliva indicates epiglottitis

60
Q

Classifcation of croup severity?

A

Stridor, subcostal recession, air entry, O2 sats, conscious level

Mild

Moderate

Severe

61
Q

Management of croup?

A

Mild = reassure + home with advice

Moderate = oral steroids (dex or pred) or nebulised (budesonide)

Severe = oxygen, steroids, nebulised adrenaline (NEED ANAESTHETIST)

62
Q

Cause of epiglottitis?

A

Hib

63
Q

What do you not do in epiglottitis?

A

Lie the child flat or examine the throat!

64
Q

Management of epiglottits?

A

Stabilise child and prevent anything that may precipitate total obstruction of throat.

Emergency otolaryngologist and anaesthetist

 Emergency intubation & Admit to ICU
 Blood cultures
 Steroids
 IV Abx
o 2nd/3rd gen cephalosporin – Cefuroxime/Ceftriaxome/Cefotaxime
o 7 days
 Rifampicin prophylaxis given to close contacts

65
Q

Causes of viral pneumonia?

A

Viruses = 14-35% - RSV, adenovirus, rhinovirus, parainfluenza

66
Q

Causes of bacterial pneumonias?

A

Newborn = group B strep from mother’s genital tract.
Infants and young children = RSV most common but bacterial include Strep. Pneumoniae, Chlamydia. Staph Aureus is infrequent but serious.

School age = Strep. Pneumoniae, Mycoplasma Pneumoniae, Chlamydia Pneumoniae.

All ages – should consider mycoplasma tuberculosis.

67
Q

Management of mild chest infections?

A

At home

Oral abx
Fluid/temp control/safety net

68
Q

Management of pneumonia?

A

Admit to ward
Oxygen to maintain sats >92
IV abx/IV fluids
Close obs for deterioration

69
Q

Antibiotics in pneumonia?

A
  • <5 years - Strep Pneumoniae most likely cause  Amoxicillin
  • > 5 years – Mycoplasma Pneumoniae more common  Macrolide
  • If Staph Aureus suspected or severe pneumonia  Co-amoxiclav, cefotaxime or cefuroxime
70
Q

Common cause of tonsillitis?

A

Group A B-haemolytic strep

EBV

71
Q

Centor criteria?

A
  • Absence of cough
  • History of fever
  • White tonsillar exudate
  • Cervical lymphadenopathy
  • Age under 15 add 1 point

0 or 1 – No antibiotic or throat culture necessary (risk of strep. infection <10%)
2 or 3 - Should receive a throat culture and treat with an antibiotic if culture is positive (risk of strep. infection 32% if 3 criteria, 15% if 2)
4 or 5 - Consider rapid strep testing and or culture. (Risk of strep. infection 56%).

72
Q

Management of tonsillitis?

A

Most cases viral –> no abx, supportive management.

If group A B-haemolytic strep suspected, should give Abx after throat swab for bacterial culture.
 Penicillin or Erythromycin
 10 day course required.
 Avoid amoxicillin because may cause maculopapular rash in cases of EBV infection.

73
Q

Indications for tonsillectomy?

A

Recurrent severe tonsillitis (as opposed to recurrent URTIs)

Peritonsillar abscess (quinsy)

Obstructive sleep apnoea (adenoids usually removed too).

Adenoids increase in size until 8 years then regress – can narrow the airways in this time.

74
Q

Causes of otitis media?

A

Viral
- RSV and Rhinovrius

Bacterial

  • Pneumococcus
  • Haemophilus Influenzae and Maroxella Catarrhalis
75
Q

Management of otitis media?

A

Most cases resolve spontaneously – abx marginally shorted the duration of pain but have not been shown to reduce risk of hearing loss.

  • Co-amoxiclav – covers H.influenzae and Maroxella) – only tell them only to use if child remains unwell for 2-3 days.
  • Amoxicillin is widely used.
  • Neither decongestants nor antihistamines beneficial.
76
Q

Clinical features of glue ear?

A

Common between ages of 2-7 years.
Most common cause of conductive hearing loss in children. Can interfere with normal speech development. May result in learning difficulties in school.

Tympanic membrane
 Dull and retracted
 Visible fluid level
 Effusions can be serous (thin), mucoid (thick) or purulent.

77
Q

Management of glue ear?

A

Usually resolves on its own – no benefit to long term used of abx, steroids or decongestants.

In children with conductive hearing loss  grommets (ventilation tubes).

Also may benefit from adenoidectomy – adenoids may harbour organisms that can contribute to infection of Eustachian tube.

78
Q

Difference between viral wheeze and atopic asthma?

A

No interval symptoms - typically in children under 5

Absence of strong history of eczema/hay fever/asthma

79
Q

Risk factors for viral induced wheeze?

A
  • Maternal smoking
  • Prematurity
  • Asthma/allergy NOT a risk factor.
80
Q

What is persistent/recurrent wheezing?

A

preschool and school-aged children – frequent wheeze triggered by many stimuli.
Presence of IgE to common inhalant allergens; dust, pets, pollens; associated with persistence of wheezing beyond preschool years.

81
Q

Most common mutation in CF?

A

dF508 on chromosome 7

82
Q

What is screened for in CF in the guthrie test?

A

Immunoreactive trypsinogen and CFTR mutations

83
Q

Problems in CF?

A

Respiratory
- Recurrent chest infections
(Staph Aureus, Haemophilus Influenzae, Pseudomonas)
- Bronchiectasis (caused by recurrent chest infections –> persistent cough, productive of purulent sputum).

Pancreas (ducts become blocked)

  • Pancreatic enzyme insufficiency
  • Diabetes mellitus (due to scarring)
  • Malabsorption

Liver disease

Male infertility (absence of vas, or blocked ducts)

Sweat gland dysfunction (excessive concentrations of sodium and chloride in sweat).

Meconium ileus in 10-20% (Thick viscoid meconium –> blockage –> Intestinal obstruction, billious vomiting, abdominal distension and failure to pass meconium in first few days of life –> surgery)

84
Q

Sweat test in CF?

A

Concentration of chloride markedly elevated

normal = 10-40 mmol/L
CF = 60-125mmol/L

Pilocarpine iontophoresis used to stimulate sweat.

85
Q

CXR in CF?

A
  • Hyperinflation
  • Bronchial dilatation (bronchiectasis)
  • Increased AP diameter
  • Cyst and linear shadows
86
Q

Lung function tests in CF?

A
  • Obstructive pattern

- Decreased FEV1 and increased lung volumes – decreases as disease progresses

87
Q

Management of CF?

A

MDT - doctors, physio, dietician etc

RESP
physio
abx (fluclox daily and resuce, daily nebs for pseudomonas)
lung function tests, transplant, flu vaccine, portacath, nebulised DNAse/saline

Nutrition - enzymes, high calorie diet, salt supplementation, fat soluble vitamin supplements

4th Year Paeds (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions