Essential Knowledge Flashcards
Cystitis causes pain in what region?
Suprapubic region
What are the symptoms of bladder inflammation or cystitis
How is that different from UTI?
Cystitis:
Pain in the suprapubic region
Pain during urination and relieved after voiding
Increased frequency and urgency of urination
In UTI it is the same as above but is an actual infection not just an inflammation => also includes fevers, chills, vomiting and nausea
pyelonephritis causes pain in what region
Flank pain on either side
What is the Triad of Hypoglycemia (Whipple’s Triad)?
- Symptoms of hypoglycemia (Tachycardia, shaking, sweating, irritability/confusion, dizziness, sweet cravings, lethargy)
- Low serum glucose in the presence of the symptoms
- Restoration of normal glucose levels leads to the reversal/improvement of symptoms
Note: remember diabetes is the inability for the body to control blood sugar levels due to desensitization of the insulin receptors (alpha Langerhans) => these symptoms are often present in diabetes especially type 1
What is the triad of hyperglycemia/Diabetes?
What are other symptoms of hyperglycemia?
- Polyuria
- Polydipsia
- Polyphagia (sweet/carb craving)
Others: Lethargy, blurred vision, unintentional weight loss, recurrent infections, headaches
What is the normal urine output?
What is considered oliguria in adults, children, and infants?
1ml/kg/hour, urinating atleast once every 6 hours
Adults: <500ml/day
Children: <0.5ml/kg/hour
Infants: <1ml/kg/hour
What is included in a urine dipstick (Dont memorize just take a look every now and again and score based on how competent you think you are now)
Specific Gravity
pH
Protein
Leucocytes
Nitrites
Blood
Ketones
Glucose
Bilirubin
Urobilinogen
What do you expect to find on a urine dipstick of a UTI
Leukocytes
Nitrites
Possibly blood
What radiological test would you conduct on a patient with a UTI?
US abdomen
What antibiotic would you prescribe for a UTI?
Trimethoprim or Nitrofentoin
You are examining anX-ray and notice a little bit of extra white within one of the lungs. What would you call it?
Opacification NOT consolidation
What is the rule of thumb antibiotic?
Ceftriaxone (3rd generation cephalosporin)
What type of fluid would you administer on fluid maintenance. How much fluid would you give?
0.9% NaCl or normal saline
Hartmann’s
Dextrose (not in resussitation)
4/2/1 or 100/50/20 rule (/24)
both based on first 10kg/10-20kg/20kg+
What type of fluid would you administer on resussitation. How much fluid would you give?
0.9% NaCl or normal saline
Hartmann’s
10-20ml/kg
What are the signs of sepsis for a child <3
Hyper/hypothermia (<36 or >38)
Hyper/hypoglycemia (increased risk)
!Periumbilical flare!
Tachypnea
Tachycardia (Pulse)
Not feeding or drinking, instead vomiting (blood?)
Sunken eyes, fontanelle
Less responsive, irritable, difficult to console
Stiff neck
What are the signs of sepsis >3 years old?
Altered mental state
Hypo/hyperthermia <35 or >38
Tachypnea >20/min
Tachycardia >90
WCC <4 or >12
Thrombocytopenia (<100,000)
BP <90mmHg systolic
SpO2 <90%
Reduced Capillary Refill >2s (Sternum)
What is caffeine used for in neonates?
Respiratory stimulant
What is the difference between enteral and parenteral feeding? Which would be used and which would be ceased in necrotising enterocolitis of the newborn
Enteral feeding is a feeding tube such as nasogastric tube that goes through the digestive system
Parenteral feeding such as TPN bypasses the digestive system altogether and is directly inserted into the blood via IV
Enteral feeding is ceased during necrotising enterocolitis and can even instigate it as blood
In a hemorrhage, what medication would you immediately begin administering? What is it’s MOA/class?
Trancxamic acid. Anti-fibronolytic agents.
What is Coarctation of the aorta? What is usually used to confirm the diagnosis. What is the cheapest method of confirming this.
Narrowing of a certain part of the aorta
ECHO but it can be seen on routine chest Xray or CT angio
Child comes in with a runny nose, sore throat, and dry cough. How would you determine if this is a viral or bacterial infection based on a blood test. What are the clinical symptoms of a bacterial infection?
1) Complete WBC count: Elevated in bacterial (leukocytosis) and normal/low in viral (leucopenia)
2) Differential WBC count: Increased neutrophils in bacterial vs increased lymphocytes in viral
3) C-reactive protein only indicates inflammation not infection: typically raised in bacterial and normal in viral
4) Procalcitonin: Elevated in bacterial, normal in viral
5) Blood cultures for bacterial, PCR for viral
Clinical symptoms: Bacterial would have high fever, localised pain, and a productive cough usually.
Where is needle thoracocentesis placed?
2nd intercostal space, MCL
Where is the chest drain inserted?
4/5th inctercostal space, MAL
What medication would you give to reduce intracranial pressure in a patient with raised ICP?
Osmotic diuretic (mannitol)
Hypertonic saline
In an emergency station on an infant (<1), where would you try to gain IV access for fluids? If that doesn’t work where would it be best to insert a line?
You give fluids and notice that perfusion is not improving. What else can you administer?
Antecubital fossa
Interosseous via the anterior tibia
Inotrope (epinephrine/adrenaline)
In patients with reduced kidney function or kidney injury. What analgesics should not be used? why?
NSAIDS e.g. ibuprofen as they can cause further damage and interstitial nephritis
In an emergency station, how would you treat hypoglycemia?
IV access/interosseous access with a bolus of 5-10% dextrose (more if younger) at 2ml/kg. followed by the Same concentrations used in maintenance using the 100-50-20ml/kg/day or 4/2/1 rule
What is a suppository?
Delivering medication Par rectum. Patients may refer to it as the one specifically used to induce bowel movements
You are in an emergency station, what antibiotics would you administer to a child
<8 weeks
>8 weeks
<8 weeks => triple therapy of amoxicillin, gentamicin, and cefotaxime
>8 weeks => cefotaxime only
Emergency: What should you do a few minutes after
administering oxygen
administering a bolus of IV fluids
administering a bolus of 2ml/kg dextrose?
CHECK (immediately after oxygen tho) CHECK CHECK (20-30 mins)
What organisms may cause reactive arthritis?
Chlamydia
Campylobacter
Salmonella
What is considered hypotension in a child >1 year old?
Systolic BP < 70 + (2xage) => for a 10 year old, <90
What are the causative pathogens of Hemolytic Uremic Syndrome?
shigella and SHEC - shigella toxin producing E.coli
What is included in a U&E
Urea:
Urea is a waste product produced by the liver as a result of protein metabolism. It is filtered by the kidneys and excreted in urine. Elevated levels of urea in the blood may indicate kidney dysfunction.
Creatinine:
Creatinine is a waste product produced by the muscles. Like urea, it is filtered by the kidneys, and blood levels are a key indicator of renal function. Elevated creatinine levels can be a sign of impaired kidney function.
Electrolytes:
The electrolytes measured in a U&E test include:
Sodium (Na): Sodium is important for maintaining fluid balance and nerve function.
Potassium (K): Potassium is crucial for nerve and muscle function, including the heart.
Chloride (Cl): Chloride, along with sodium, helps maintain fluid balance.
Estimated Glomerular Filtration Rate (eGFR):
eGFR is a calculated value that estimates how well the kidneys are filtering waste from the blood. It is often reported alongside creatinine levels to provide a more comprehensive assessment of kidney function.
What type of drug is dexamethasone? Where is it used?
Oral steroids used in the management of croup
When asked for investigations, what should you always include
Relevant examinations
Ask for review from a senior colleague
Plot Centiles for height weight and OFC
When asked for management, what should you include everytime
Patient and family education on topic with signs to look out for if the situation deteriorates or give relevant pamphlet with information on topic to reassure parents
Describe the pain presentation of a case of acute appendicitis. Explain why
Starts in umbilicus and then migrates to the right to mcburney’s point on the right side. Why? As inflammation intensifies, it will irritate structures surrounding the area including the peritoneum. This allows localization of the pain
Whereis the pain? 1/3 from ASIS to Umbilicus
What are the normal glucose levels in paediatric emergencies
4-7 mmol/L
