Final FC Flashcards
What are the three components of GCS, and what are they out of?
Eye opening: /4
Verbal: /5
Motor: /6
Explain the criteria for eye opening in GCS
4: spontaneous opening
3: open to voice
2: open to pain
1: NO opening
Explain the criteria for verbal response in GCS if >5yo
5: alerted to time and place
4: confused
3: inappropriate words
2: incomprehensible sounds
1: no response
Explain the criteria for verbal response in GCS if <5yo
5: ALERT, BABBLES, COOS AS NORMAL
4: less thna normal
3: cries to pain
2: moans to pain
1: no response
Explain criteria for motor response in CGS
6: obeys commands
5: localises to pain/ withdraws from touch
4: withdraws from pain
3: flexes to pain
2: extends to pain
1: NO response
What are criteria for mild / moderate / severe DKA
mild: pH >7.2
Mod: pH 7.2-7.1
Severe: pH <7.1
What are the correct times for performing CVS vs amniocentesis
Chorionic villus sampling: 11-14 weeks
amniocentesis: 15+
what is first line management for absence seizures
ethosuximide
what causes a reflex anoxic seizure
Sudden unexpected fright /pain
what causes a breath holding spell
vigorous crying / sobbing
Explain pre-during-after of reflex anoxic seizure
Pre: sudden unexpected fright or pain
During: cyanotic/grey colour, LOC, limp/stiff, clonus, twitch, lasts few mins, regain conscioussnes
After: gradual
Explain pre-during-after of breath holding spell
Pre: vigorous crying and sobbing
During: child becomes silent, holds breath on exhaltionl, cyanotic, brief LOC
After: regain consciusness after less than a min
what are the age appropriate doses of adrenaline in anaphylaxis
<6yo: 150 mcg of 1:1000
6-12yo: 300 mcg
12+: 500 mcg
What is early approach (before adrenaline) approach to anaphylaxis
Remove trigger if possible Call for help early Lie patient flat and raise legs ABCDE assessment Administer adrenaline
what is management of anaphylaxis once skills and equipment bvecome available
Establish airway
High flow oxygen
IV fluid challenge
Administer chlorphenamine and hydrocortisone
Attach patient to monitoring (pulse oximetry, ECG, BP)
What are indications for referring children with possible seizure
Refer URGENTLY ALL children suspected of having a first epileptic seizure to NEUROLOGIST
What advice do you give to child presenting with possible seizure
- advise parent / carer how to recognise seizure
- Record all future episodes by video
- Avoid dangerous activities until diagnosis is confirmed
- Seek help if another seizure occurs before referral
What antiepileptic is preferred to valproate in young girl of childbearing ager
lamotrigine
What precautions must you take for child with epilepsy for sports?
Avoid situations where having a seizure could lead to death:
- bicycle: wear helmet and avoid busy roads
- swimming: observed 1:1
- climbing: helmet and harness up wall
- driving: not allowed until no seizures for up to one year
What are risks of not taking epilepsy medication?
- trauma during tonic clonic seizure
- hypoxic brain injury if prolonged
- seizures may become progressively worse, leading to status epiletticus
- SUDEP (Sudden Unexpected Death in Epilepsy) - 1:1000 die, more common if poorly controlled seizures
What TRIAD occurs with West Syndrome
- infantile spasm
- developmental delay
- Hypsarrythmia on EEG
Describe an infantile spasm
flexion of waist, trunk and arms > extension of arms
very brief, only lasts few seconds
occur in clusters
What are the red flags for a brain tumour as indicated by the HEADSMART guidelines?
- Headache - persistent, most days, wakes up child, child disoriented
- Vomiting - persistent, wakes up child, with headache, without nausea/vomiting
- Eyes - abnormal movement, vision blurred/lost (moves head to compensate / clingy in unknown surroundings)
- Loss of balance/coordination (regression in previously aquired skills)
- Behaviour change - tired, lack of enthusiasm
- Neck - still, head tilted, wry neck
what is the most common form of epilepsy in children
Benign Rolandic Epilepsy
What age range does Benign Rolandic Epilepsy occur
8 years old to 14-18 years old
What are the FOUR key sx of Benign Rolandic Epilepsy
benign focal epilepsy, consciousness in maintained
- Unilateral facial sensorimotor symptoms (sudden contraction of half of mouth/face)
- Oropharyngeal ictus (paraesthesia inside mouth, strange sounds)
- Arrest of speech (mouth opens but cannot speak)
- Hypersalivation (mouth full of saliva)
How do you manage Benign Rolandic Epilepsy
mostly conservative, will self resolve
what are 2 resources for epilepsy
Epilepsy action
Epilepsy society Uk
What ix confirms malrotatio
Upper GI contrast study
How can you treat Wilsons disease
Penicillamine
Explain NICE guidelines for traumatic head injury
- Loss of consciousness >5mins
- Abnormal drowsiness
- Vomiting x3 or more
- Dangerous mechanism of injury
- Amnesia > 5mins
- On warfarin
if 0-1: observe for 4h
if 2+: urgent CT
Immediate CT and trauma call if:
- GCS<15
- suspected open/depressed skull fracture
- seizure
- focal neuro deficit
What is Waterhouse-Friderichsen syndrome.
Meningococcal meningitis + septicaemia
+ ADRENAL HAEMORRHAGE + SHOCK
what score can you use for croup?
Westley Croup Score
What is the appropriate treatment for duodenal aatresia?
Duodenoduodenostomy
Long term complications of sickle cell anaemia
short stature, delayed puberty
Stroke, cognitive impairment, neuro damage
adenotonsillar hypertrophy (OSA)
cardiac enlargement - from chronic anaemia
heart failure - from uncorrected anaemia
pigment gallstones
PSYCHOSOCIAL PROBLEMS - due top time off school
What prophylaxis can you give for sickle celll
- immunise against encapsulated organisms
- daily oral penicillin
- daily oral folic acid
- avoid triggers from vaso occlusive crises
How do you treat an acute crisis in sickle cell
Analgesia Good hydration Infection with antibiotics Oxygen Exchange itranfusion for Acute Chest Syndrome, priaprism, stroke
what is the sign for acute appendicitis called, and what does it mean
Rosving’s sign
Upon releasing pressure from palpation of the LIF, patient will feel pain on the RIF
How would you measure fever in a child?
Temp dot in axilla if <4wks
Tympanic membrane if >4wks
What are features of simple vs complex febrile convulsions?
Simple:
- less than 15 min duration
- tonic clonic
- resolve spontaneously
- do not recur within 24h
- milf post ictal phase, complete recovery within 1h
Complex:
- > 15 mins
- focal at onset
- recurrence within 24 h or in same febrile illness
- prolonged ictal fase
when would you get EEG vs MRI for seizures?
if generalised: only MRI
if focal: MRI+ EEG
Limit ages for gross motor
Sit unsupported: 9m
Stand: 12m
Walk: 18m
LImit ages for vision and fine motore
Transfer objects between hands 9m
Pincer grip 12m
Social and behaviour limit ages
smile: 10 weeks
spoon to mouth: 18m
Hearing and speech limit ages
First word: 12 months
6 words: 18 months
3 word sentences: 3 years
How do you manage acute migraine
Nasal triptan + NSAID /paracetamol
How do you manage prophylaxis for migraines
Propanolol + topiremate (carbonic anhydrase inhibitor)
What guidelines can you use for classifying headaches
International headache society criteria
Complications of meningococcal septicaemia
Hearing loss Learning problems Epilepsy (due to brain injury) Kidney problems Joint/bine probkems (scarring in tissue)
WHat age children do you treat for bedwetting
OVER 5 YEARS OLD ONLY
What is management for bedwetting
- Star chart/reward system - for agreed behaviour (don’t drink before bed, go toilet) NOT for dry nights
- Bell and pad alarm >7yo
- SHort term relief: desmopressin
- Refer to paeds specialist: ipiramine /oxybutinin
What dose lorazepam do you give in an epileptic child
0.1mg/kg IV up to 4kg
What do anaesthetists do if no response to all the antiepileptic meds you can give during tonic clonic seizure
Rapid sequence induction using thiopentone, intubation and ventilation
Transfer to ICU
What outlook advice can you give for epilepsy
Outlook is better than people imagine
- 5 in 10 people have no seizures at all over 5 year period
- 3 in 10 will have some seizures, but fewer than if they didnt take meds
- in total, 8 in 10 are wekll controlled with either no or few seizures
What are the dose of buccal midazolam/ rectal diazepam given in seizures
0.5mg/kg
what children are at high risk of DKA
- peripubertal/adolescent girls
- difficult home life
- eating disorders
- limited access to health service
What can the duration of an anaphylactic reaction be?
You can have a BIPHASIC reaction
With second reaction occurring 4-6 hours after the initial one
so all patients need to be monitored in hospital up to 6 hours after their initial reaction
What can you measure to confirm anaphylaxis reaction during the episode
Mast cell tryptase
what does RDS look like on CXR
Ground glass opacity
remember - it occurs from lack of surfactant
How do you manage RDS?
intratracheal artificial surfactant
explain what a splenic seq crisis is like i’m a two year old
sickle cells blood the blood vessels leading out of the spleen
this traps bloods in the spleen (splenic pooling of blood)
This causes acute splenomegaly + pallor, fatigue
Explain blood count in splenic crisis
low Hb, low reticulocytes
Howell Jolly bodies
another name for the mantoux test
Tuberculin skin test
What ranges on mantoux test indicate TB
> 15 : always TB
10-15: TB if high risk
5 if HIV positive or recent contact with active TB
How do you give fluids in children if you cannot get an IV access?
IO
What is the FIRST test to do in a child with language delay?
Hearing test (evoked audiometry)
What are common complication of chicken pox in children
Secondary skin infection (by strep/staph)
Investigations for precocious puberty:
FIRST LINE:
- bone age assessment (left hand X ray)
- LH, FSH (helps distinguish gonadotrophin indep vs dep)
- serum testosterone, oestrongen (helps confirm onset of puberty)
- USS pelvis (exclude oestrogen secreting ovarian tumour)
- LHRH stim test (Gonadotroph indep vs indep)
SECOND LINE:
MRI brain etc
What criteria other than CENTOR can you use when deciding if you should give Abx to tonsillitis? + explain
FeverPAIN
- Fever (during previous 24 hours)
- Purulence (pus on tonsils)
- Attend rapidly (within 3 days after onset of symptoms)
- Inflamed tonsils
- No cough or coryza (inflammation of mucus membranes in the nose)
Each of the FeverPAIN criteria score 1 point (maximum score of 5).
Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause.
A score of 4/5 = 60% likelihood of isolating streptococcus.
when should you recheck bilirubin in a baby with bilirubin that is <50mmol below threshold line?
recheck within 18 hours
How does aortic stenosis present on ascultatyion
Ejection systolic murmur at the RIGHT UPPER sternal edge.
How does ASD present on ascultation
Ejection systolic on LEFT upper sternal edge
How does osteosarcoma present differently to Ewing’s sarcoma
Osteosarcoma: most common, affects distal femur/proximal tibia
Ewing: presents similarly to infection with fever. most likely affects DIAPHYSIS (SHAFT)\
what maternal disease is Tranposition of the Great Arteries associated with
maternal diabetes
How can you estimate the. weight in kg for a child 1-5 yo?
2x age + 8
what is a positive prehn’s test and what does it indicate
relief of pain upon elevation of the testicle
indicates epidydimitis
What does a peritonsillaar abscess look like
unilateral tonsillar swelling + pus ON JUST ONE TONSIL
what do you do if baby is DDH + on NIPE?
review in clinic with USS in 2 weeks!
Viral causes of gastroenteritis & features
Rotavirus - 5-7 days, vomiting+ diarrhoea + fever
Norovirus 1-3 days, vomiting (>diarrhoea)
Adenovirus: mild vomiting > diarrhoea 2 weekz
RDS on CXR
ground glass
TTN on CXR
interstitial lines, small effusions
pulmonary oedema in the neonate
usually associated with caesarian section delivery
meconium aspiration on CXR
IN TERM/POSTDATES
- bilateral PATCHY airspace shadowing
- large volume lungs
- small pleural effusions
What does broncopulmonary dysplasia look like on CXR
areas of opacification
cystic changes
what infectious disease is spreading in north london
measles
