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Y5 Paediatrics > Final FC > Flashcards

Final FC Flashcards

1
Q

What are the three components of GCS, and what are they out of?

A

Eye opening: /4
Verbal: /5
Motor: /6

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2
Q

Explain the criteria for eye opening in GCS

A

4: spontaneous opening
3: open to voice
2: open to pain
1: NO opening

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3
Q

Explain the criteria for verbal response in GCS if >5yo

A

5: alerted to time and place
4: confused
3: inappropriate words
2: incomprehensible sounds
1: no response

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4
Q

Explain the criteria for verbal response in GCS if <5yo

A

5: ALERT, BABBLES, COOS AS NORMAL
4: less thna normal
3: cries to pain
2: moans to pain
1: no response

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5
Q

Explain criteria for motor response in CGS

A

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

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6
Q

What are criteria for mild / moderate / severe DKA

A

mild: pH >7.2
Mod: pH 7.2-7.1
Severe: pH <7.1

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7
Q

What are the correct times for performing CVS vs amniocentesis

A

Chorionic villus sampling: 11-14 weeks

amniocentesis: 15+

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8
Q

what is first line management for absence seizures

A

ethosuximide

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9
Q

what causes a reflex anoxic seizure

A

Sudden unexpected fright /pain

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10
Q

what causes a breath holding spell

A

vigorous crying / sobbing

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11
Q

Explain pre-during-after of reflex anoxic seizure

A

Pre: sudden unexpected fright or pain
During: cyanotic/grey colour, LOC, limp/stiff, clonus, twitch, lasts few mins, regain conscioussnes
After: gradual

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12
Q

Explain pre-during-after of breath holding spell

A

Pre: vigorous crying and sobbing
During: child becomes silent, holds breath on exhaltionl, cyanotic, brief LOC
After: regain consciusness after less than a min

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13
Q

what are the age appropriate doses of adrenaline in anaphylaxis

A

<6yo: 150 mcg of 1:1000

6-12yo: 300 mcg

12+: 500 mcg

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14
Q

What is early approach (before adrenaline) approach to anaphylaxis

A 
Remove trigger if possible
Call for help early
Lie patient flat and raise legs
ABCDE assessment
Administer adrenaline
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15
Q

what is management of anaphylaxis once skills and equipment bvecome available

A

Establish airway
High flow oxygen
IV fluid challenge
Administer chlorphenamine and hydrocortisone
Attach patient to monitoring (pulse oximetry, ECG, BP)

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16
Q

What are indications for referring children with possible seizure

A

Refer URGENTLY ALL children suspected of having a first epileptic seizure to NEUROLOGIST

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17
Q

What advice do you give to child presenting with possible seizure

A
  • 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
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18
Q

What antiepileptic is preferred to valproate in young girl of childbearing ager

A

lamotrigine

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19
Q

What precautions must you take for child with epilepsy for sports?

A

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
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20
Q

What are risks of not taking epilepsy medication?

A
  • 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
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21
Q

What TRIAD occurs with West Syndrome

A
  • infantile spasm
  • developmental delay
  • Hypsarrythmia on EEG
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22
Q

Describe an infantile spasm

A

flexion of waist, trunk and arms > extension of arms
very brief, only lasts few seconds
occur in clusters

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23
Q

What are the red flags for a brain tumour as indicated by the HEADSMART guidelines?

A
  • 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
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24
Q

what is the most common form of epilepsy in children

A

Benign Rolandic Epilepsy

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25
Q

What age range does Benign Rolandic Epilepsy occur

A

8 years old to 14-18 years old

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26
Q

What are the FOUR key sx of Benign Rolandic Epilepsy

A

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)
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27
Q

How do you manage Benign Rolandic Epilepsy

A

mostly conservative, will self resolve

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28
Q

what are 2 resources for epilepsy

A

Epilepsy action

Epilepsy society Uk

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29
Q

What ix confirms malrotatio

A

Upper GI contrast study

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30
Q

How can you treat Wilsons disease

A

Penicillamine

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31
Q

Explain NICE guidelines for traumatic head injury

A
  • 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
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32
Q

What is Waterhouse-Friderichsen syndrome.

A

Meningococcal meningitis + septicaemia

+ ADRENAL HAEMORRHAGE + SHOCK

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33
Q

what score can you use for croup?

A

Westley Croup Score

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34
Q

What is the appropriate treatment for duodenal aatresia?

A

Duodenoduodenostomy

35
Q

Long term complications of sickle cell anaemia

A

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

36
Q

What prophylaxis can you give for sickle celll

A
  • immunise against encapsulated organisms
  • daily oral penicillin
  • daily oral folic acid
  • avoid triggers from vaso occlusive crises
37
Q

How do you treat an acute crisis in sickle cell

A 
Analgesia 
Good hydration 
Infection with antibiotics 
Oxygen 
Exchange itranfusion for Acute Chest Syndrome, priaprism, stroke
38
Q

what is the sign for acute appendicitis called, and what does it mean

A

Rosving’s sign

Upon releasing pressure from palpation of the LIF, patient will feel pain on the RIF

39
Q

How would you measure fever in a child?

A

Temp dot in axilla if <4wks

Tympanic membrane if >4wks

40
Q

What are features of simple vs complex febrile convulsions?

A

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
41
Q

when would you get EEG vs MRI for seizures?

A

if generalised: only MRI

if focal: MRI+ EEG

42
Q

Limit ages for gross motor

A

Sit unsupported: 9m
Stand: 12m
Walk: 18m

43
Q

LImit ages for vision and fine motore

A

Transfer objects between hands 9m

Pincer grip 12m

44
Q

Social and behaviour limit ages

A

smile: 10 weeks

spoon to mouth: 18m

45
Q

Hearing and speech limit ages

A

First word: 12 months
6 words: 18 months
3 word sentences: 3 years

46
Q

How do you manage acute migraine

A

Nasal triptan + NSAID /paracetamol

47
Q

How do you manage prophylaxis for migraines

A

Propanolol + topiremate (carbonic anhydrase inhibitor)

48
Q

What guidelines can you use for classifying headaches

A

International headache society criteria

49
Q

Complications of meningococcal septicaemia

A 
Hearing loss 
Learning problems 
Epilepsy (due to brain injury) 
Kidney problems 
Joint/bine probkems (scarring in tissue)
50
Q

WHat age children do you treat for bedwetting

A

OVER 5 YEARS OLD ONLY

51
Q

What is management for bedwetting

A
  1. Star chart/reward system - for agreed behaviour (don’t drink before bed, go toilet) NOT for dry nights
  2. Bell and pad alarm >7yo
  3. SHort term relief: desmopressin
  4. Refer to paeds specialist: ipiramine /oxybutinin
52
Q

What dose lorazepam do you give in an epileptic child

A

0.1mg/kg IV up to 4kg

53
Q

What do anaesthetists do if no response to all the antiepileptic meds you can give during tonic clonic seizure

A

Rapid sequence induction using thiopentone, intubation and ventilation
Transfer to ICU

54
Q

What outlook advice can you give for epilepsy

A

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
55
Q

What are the dose of buccal midazolam/ rectal diazepam given in seizures

A

0.5mg/kg

56
Q

what children are at high risk of DKA

A
  • peripubertal/adolescent girls
  • difficult home life
  • eating disorders
  • limited access to health service
57
Q

What can the duration of an anaphylactic reaction be?

A

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

58
Q

What can you measure to confirm anaphylaxis reaction during the episode

A

Mast cell tryptase

59
Q

what does RDS look like on CXR

A

Ground glass opacity

remember - it occurs from lack of surfactant

60
Q

How do you manage RDS?

A

intratracheal artificial surfactant

61
Q

explain what a splenic seq crisis is like i’m a two year old

A

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

62
Q

Explain blood count in splenic crisis

A

low Hb, low reticulocytes

Howell Jolly bodies

63
Q

another name for the mantoux test

A

Tuberculin skin test

64
Q

What ranges on mantoux test indicate TB

A

> 15 : always TB
10-15: TB if high risk
5 if HIV positive or recent contact with active TB

65
Q

How do you give fluids in children if you cannot get an IV access?

A

IO

66
Q

What is the FIRST test to do in a child with language delay?

A

Hearing test (evoked audiometry)

67
Q

What are common complication of chicken pox in children

A

Secondary skin infection (by strep/staph)

68
Q

Investigations for precocious puberty:

A

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

69
Q

What criteria other than CENTOR can you use when deciding if you should give Abx to tonsillitis? + explain

A

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.

70
Q

when should you recheck bilirubin in a baby with bilirubin that is <50mmol below threshold line?

A

recheck within 18 hours

71
Q

How does aortic stenosis present on ascultatyion

A

Ejection systolic murmur at the RIGHT UPPER sternal edge.

72
Q

How does ASD present on ascultation

A

Ejection systolic on LEFT upper sternal edge

73
Q

How does osteosarcoma present differently to Ewing’s sarcoma

A

Osteosarcoma: most common, affects distal femur/proximal tibia

Ewing: presents similarly to infection with fever. most likely affects DIAPHYSIS (SHAFT)\

74
Q

what maternal disease is Tranposition of the Great Arteries associated with

A

maternal diabetes

75
Q

How can you estimate the. weight in kg for a child 1-5 yo?

A

2x age + 8

76
Q

what is a positive prehn’s test and what does it indicate

A

relief of pain upon elevation of the testicle

indicates epidydimitis

77
Q

What does a peritonsillaar abscess look like

A

unilateral tonsillar swelling + pus ON JUST ONE TONSIL

78
Q

what do you do if baby is DDH + on NIPE?

A

review in clinic with USS in 2 weeks!

79
Q

Viral causes of gastroenteritis & features

A

Rotavirus - 5-7 days, vomiting+ diarrhoea + fever
Norovirus 1-3 days, vomiting (>diarrhoea)
Adenovirus: mild vomiting > diarrhoea 2 weekz

80
Q

RDS on CXR

A

ground glass

81
Q

TTN on CXR

A

interstitial lines, small effusions
pulmonary oedema in the neonate

usually associated with caesarian section delivery

82
Q

meconium aspiration on CXR

A

IN TERM/POSTDATES

  • bilateral PATCHY airspace shadowing
  • large volume lungs
  • small pleural effusions
83
Q

What does broncopulmonary dysplasia look like on CXR

A

areas of opacification

cystic changes

84
Q

what infectious disease is spreading in north london

A

measles

Y5 Paediatrics (30 decks)

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