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Gen Medicine Flashcards

1
Q

Recognising the seriously ill child using traffic lights

A

GREEN: feeding ok, norm colour, responds to social cues, normal RR, wakens quickly

AMBER: 50% of feeds, pale, not responding to social cues, hard to waken, decreased activity levels, tachypnea, sats 3 secs

RED: pale and mottled, ashen colour or blue, doesnt stay awake, decreased GCS, decreased skin turgor, GRUNTING signs**

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2
Q

Recognising the seriously ill child using traffic lights

A

GREEN: feeding ok, norm colour, responds to social cues, normal RR, wakens quickly

AMBER: 50% of feeds, pale, not responding to social cues, hard to waken, decreased activity levels, tachypnea, sats 3 secs

RED: pale and mottled, ashen colour or blue, doesnt stay awake, decreased GCS, decreased skin turgor, GRUNTING signs**

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3
Q

GRUNTING signs

A 
G - grunt/high pitched cry
R - rib recession/ RR up
U - unequal pupils
N - no use of limbs
T - temp change + cld periph
I - 
N - neck rigidity
G - green bile in vomit
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4
Q

normal HR and RR for age

A
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5
Q

Possible causes of severe ill child

A

sepsis, meningitis, volvulus, hypoglycaemia, arrythmia, gastroent

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6
Q

Possible causes of severe ill child

A

sepsis, meningitis, volvulus, hypoglycaemia, arrythmia, gastroent

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7
Q

3 main laws for child protection Scotland

A

1995 - children scotland act

2007 - protection of vulnerabl groups

2014 - children and young people act

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8
Q

normal HR and RR for age

A
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9
Q

Immediate Management of Seriously Ill Child?

A
  1. Fit O2 mask and 100% O2
  2. IV access (OS if no access) + give colloid fluid (measured bt weight!!!)
  3. call PICU
  4. Measure BM, U+E (HCO3), FBC, CROSSMATCH (if trauma or anaemic)
  5. other tests (MRI, US, LP)
  6. swabs and cultures BEFORE antibiotics
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10
Q

Possible causes of severe ill child

A

sepsis, meningitis, volvulus, hypoglycaemia, arrythmia, gastroent

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11
Q

Common Symptoms of normal child - crying/ 3 month colic/ nappy rash

A

Crying - worst 6-8 weeks

3 month colic- paroxysmal crying + retracting legs to tummy >3 hrs >3 days/week
TREAT - finish full feed / add lactase to formula + reduce stress

Vomiting - only worrisome if V.Large Vol
C) GRD, overfeeding, pyloric sten (8weeks) UTI
bile green = volvulus!!!

Nappy Rash - either

  • ammonia derm (caused by moisture, excluded skin folds)
  • candida (satellite spots beyonf rash are diagnostic)
  • sebhorric derm (diffuse red shiney rash extending into skin folds +/- scalp)

TREAT for all - change nappy, leave naked if poss, dry thoroughly +/- ABx’s (clotrimazole)

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12
Q

3 main laws for child protection Scotland

A

1995 - children scotland act

2007 - protection of vulnerabl groups

2014 - children and young people act

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13
Q

Methods of Feeding a sick Child?

A

NG tube - if too ill to feed norm or resp distress
- expressed boob milk fed into tube
(if GORD then use NJ tube)

Trophic Feeding - hypo caloric feeding to ready the gut for norm feeding
(done in prems)

Parenteral - post op, trauma, burns low birthweight, gut needs rest
Comps - infection, acidosis, thrombophlebitis, gallstones

be sure to stop gradually

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14
Q

What can make breastfeeding more difficult to accomplish?

A
  • mother and baby seperated in hosp overnight
  • unfriendly working envirnment
  • committment too large for mother (6 months everday)
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15
Q

why might you choose to bottlefeed?

A
  • father can help

- quantify exact amounts of feed

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16
Q

Weaning schedule/timeline

A
  • solids introduced at 4-6 months (cereal/pureed food)
  • follow on formula tried after 6 months (more Iron + vits)
  • lumpy food
  • normal cow milk after 1 year
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17
Q

what foods to avoid before 6 months?

A

gluten, wheat, egg, fish, milk, nust, cheese, shellfish

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18
Q

Methods of Feeding a sick Child?

A

NG tube - if too ill to feed norm or resp distress
- expressed boob milk fed into tube
(if GORD then use NJ tube)

Trophic Feeding - hypo caloric feeding to ready the gut for norm feeding
(done in prems)

Parenteral - post op, trauma, burns low birthweight, gut needs rest
Comps - infection, acidosis, thrombophlebitis, gallstones

be sure to stop gradually

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19
Q

Fluid and Electrolyte requirements

A

Always calculated by weight of child!

4,2,1 rule =

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20
Q

most common fluid prescribed in paeds

A

0.45% saline/ 5% dextrose

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21
Q

Ante natal screening dates

A

FIRST TRIMESTER:
10-12 weeks - full Hx and Exam/Bloods/education/BMI & Dating US scan
11-13 weeks - USS and maternal serum screening

SECOND TRIMESTER:
16-18 weeks - serum alpha fetal protein (maternal)
15-22 weeks - AMNIO for chromosomal abnorm
18-20 weeks - fetal anomaly scan

THIRD TRIMESTER:
28 weeks - bloods/antibodies/ Glucose challenge/ HIV and syphillis screen
33-36 weeks - Gonnorhea and chlamydia screen
36+ weeks - determine presentation
41 weeks - offer induction of labour if overdue

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22
Q

Common Causes of Childhood mortality - 1-10 years and 15-19 years

A

1-10

  • Perinatal (diseases picked up through pregnancy)
  • Sudden Infant Death syndrome
  • Congenital conditionss (chromosomal, malformations, deformaities)

15-19 years
Environmental accidents (RTA, drowning, falls, suffocation)
- Suicide

any age

  • Cancer
  • Epilepsy
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23
Q

What stage of childhood are most deaths?

A

age

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24
Q

What would be seen on xray of Hyaline Membrane Disease?

A
  • diffuse ground glass lunf with reduced volume
  • bell-shaped thorax
  • bilateral + commonly symetrical
  • air bronchograms +/- hyper inflation
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25
What is hyaline mebrane disease?
respiratory distress syndrome
26
Forms of bowel obstruction in Paeds?
- Intussuseption - incarcerated hernia - volvulus - post-op adhesions - mesocolic hernia - meckel diverticula
27
What is intussuseption
large loop of bowel surrounding smaller loop providing pouch for collecting faeces.
28
Neonatal Jaundice - Causes (both types)/ I/ CF/ T
``` Unconjugated = Sepsis/ Haemoooolytic/ Breastfeeding Conjugated = Biliary Atresia ``` FBCC, Blood FIlm, Blood Grouping, Coombs ttest, syphillis screen IIf levels are so high as to cause Kernicterus the CF are: - sleepy, poor suckling, deafness, low iq, odd movements, cerebral palsy Treat with Phototherapy and exchange transfusion (via umbilical vein IVI if possible)
29
Most likely cause of jaundice >14 days
sepsis, breastfeeding, hypothyroid, Cystic Fibrosis
30
Side effects of treatment (phototherapy and exchange transfusion)
PT- labile temperature/ eye damage// diarrhoea/ seperation from mother/ fluid loss ET- (can be fatal)) bradycardia, apnoea, low platelets, hypoglyc, hyponatraemia, low O2 sats
31
What is hyperbilirubinaemia (rough level)
over 200 mmol/L bilirubin
32
What might be seen in a neo-nate with neonatal cyanosis?
Blue discolouration of mucous membranes +/- skin
33
What might cause nnnneo-natal cyanosis?
any cause of respiratoooory distress - persistant pulomnary hypertension of newborn - congenital cyanotic heart disease - tracheo-oesophageal fistula - diaphragmatic fistula
34
It is important o exclude a state of respiratory distress in neonatal cyanosis - what CF would this entail? What else should be looked for on examination?
tachypnoa, rib recession, nasal flaring, grunting - Auscultation heart (congenital heart) - Assess Abdomen (diaphragmatic herna)
35
What investigations should be done for a child with neonatal cyanosis?
Bloods - WCC (may be raised if sepsis) / hematocrit (raised if polycythaemia) / ABG's monitored to confirm cyanosis X-ray - diagnose normal causes of cyanosis (pneumothorax/ diaphragmatic hernia/ pleural effusion) ECHO - any possible CHD
36
How to treat neonatal cyanosis?
ABC approach, then establish an airway and start O2 +/- ventilation Gain IV access and draw bloods If Sepsis suspected start antibiotics broad spectrum.
37
What is the most common cause of delay/failure to pass meconium?
Hirschprungs Disease
38
What is hirschprungs disease?
congenital absence of ganglia in a segment of colon - this leads to difficulty passing stool
39
CF of Hirschprungs disease / RF / I and DDx
Failure to pass meconium, billows vomiting, Abdomen distension, failure to thrive. Downs is biggest RF - Abdomen X-ray will show air fluid levels and dilated colon - contrast enema (contracted distal bowel + dilated proximal bowel) - rectal biopsy of the aganglionic section of colon. DDx is Cystic Fibrosis (meconium ileus)
40
How to treat hirschprungs disease?
Bowel Irrigation + surgical excision of the affected area +/- colostomy
41
What is respiratory distress of the neo-nate?
this is insufficient surfactant resulting in the lungs inability to stayyyyy expanded. This causes the the baby to fatigue and possibly die.
42
What is the risk of respiratory distress in press at 24-28 weeks and 32+ weeks?
``` 24-28 = 100% 32+ = 50% ```
43
main RF for respiratory distress?
Premature birth, Fam Hx, hypothermia, maternal DM
44
response Distress : CF / I /DDx / T
tachypnoa in first 4 hours life, increased inspired effort, grunting, nasal flaring, intercontinental recession, cyanosis II - chest xray (diffuse granular pattern +/- airbronchograms) DDx - could simply be transient tachypnoa of neonate or meconium aspiration Dependant upon gestation :
45
What is used to guess severity or resp distress?
the more premature the baby, the worse the prognosis. | also if hypoxia occurs refractory to treating it is not survivable.
46
What can respiratory distress lead to if survived?
chronic lung diseases (bronchopulmonary dysplasia)
47
In what ways and at what time can congenital abnormalities be detected?
Antenatally (USS 18-20 weeks) At Birth Routine neo-natal exam Later in life
48
Causes of Congenital Abnormalities?
chomosomal abnormalities (downs/turners), secondary to intra-uterine infection, due to teratogens, assoc with other syndromes
49
CNS Congenital Abnormalities
Brain Formation abnorm: 1. Ancephaly - large portion scalp/cerebrum doesnt develop. detected antenatally.fatal 2. Encephalocele - Neural Tube D. Brain and meninges protrude through midline defect in skull 3. Microcephaly - small head due to incomplete brain development (Caused - TORCH infection/ maternal IVDU/ perinatal hypoxia) 4. Spina Bifida - range of NTD's 5. Sacral Pit - dimple/indentation over sacral area.
50
ENT Congenital Abnorm (CF,C,T)
Cleft palate/lip - 1 in 1000 - uni or bilateral CF - feeding and speech problem C - failure of fusion of maxillary processes T - Lip is repaired at 3 months // palate repaired at 6-12 months
51
GI congenital abnormalities (CF,C,T)
- tracheo-oesophageal fistula CF - coughing/choking during feeding, abdo distension T - surgery - Duodenal atresia - 1 in 5000 C - assoc w/ Downs CF - billous vomiting T - double bubble seen on abdo xray - pyloric stenosis (covered in detail later) - malrotation - hirschprungs - hernia's - undescended testes
52
GUM congenital abnormalities (CF,C,T)
- hypospadius CF - urethral opening on underside penis T - surgery at 12-18 months - imperforate anus - 1 in 5000 shortly after birth no meconium has been passed + billous vomiting + abdo distension
53
Respiratory congenital abnormality (how found/ CF/ prognosis)
Diaphragmatic hernia - 1 in 2400 - most on Left side I - detected on antenatal scan CF - mimic dextracardia + respiratory distress Prognosis - if caught on scan = 20% survival // if at birth 60% survival
54
MSK Congenital Abnorms (?/ inheritance pattern/ CF) + name of others covered elsewhere
Achondroplasia AD condition but also can be spontaneous mutation. CF - short limbs, large head, lumbar lordosis +/- club foot, hydrocephalus Dev dysplasia of Hip Club Foot (Talipes Equinovarus) Polydactyly/ syndactyly
55
DOWNS (?/ RF/ I/ CF/ assoc diseases/ seen on exam)
DOWNS - trisomy 21 - 1 in 1000 RF - increased parent age I - Bloods (B-hCg, PAPP-A) / CVS or Amnio CF - Upwards slanting palpebral fissure, prominent epicanthic fold, protrusing chin, flat nose, round face, low-set ears Ass Dis - CV=50% have a CHD (AVSD most common, then VSD) GI= risk of hirschprungs, duodenal atresia, imperforate anus, GORD Hx - low IQ, strabismus/cateract, epilepsy risk, spinal cord compression O/E - hypotonia, short neck, single palmar crease, short stature, short skull
56
Other Chromosomal Abnorm (?/ CF)
EDWARDS - trisomy 18 CF - same as DOWNS + rocket bottom feet + CHD's PATAU's - trisomy 15 CF - polydactyly, skin defects, cardiac and renal defects, eye defects TURNERS - 45XO - only girls CF - webbed neck, short stature, lymphoedema, downard turned mouth, co-arctation of aorta, NORMAL IQ, decreased sexual development KLINEFELTERS - XXY - boys only CF - Tall, infertile, gynacomastia, hypogonadism, mild learning diff FRAGILE X CF - Long face, Big Ears, Large Chin, Learning DIff/ Behavioural Diff, Autistic
57
What are the TORCH infections
``` Toxoplasmosis Other (syphilis) Rubella Cmv HSV ```
58
ToRCH infections (spread, CF)
Toxoplasmosis - parasite spread via food/water CF - hydrocephalus, cerebral palsy, epilepsy, CHORIORETINITUS(inflamed choroid), focal neuro defecit Rubella - viral - self-limiting (normal) - passed from mother CF - mild fever, rash, lymphadenopathy, conjunctivitis CMV CF - in paeds - Risk of heading loss, mental retardation, neuro abnormalities - similar to mono in adults(fever, lymphadenopathy, atypical lymphocytosis) T - gangcyclovir
59
Congenital Abnorm due to Teratogens - common causes
Alcohol, phenytoin, sodium valproate, lithium, warfarin, tetracycline
60
Foetal Alcohol - CF + assoc
Microcephaly, hypoplastic upper lip, absent philtrum, small eyes, epicanthic folds decreased IQ and cardiac defects are common
61
CF's teratogen Phenytoin Lithium Warfarin
Phenytoin - cleft lip/palate, cardiac defects, hypoplastic nails, crano-facial abnorms Lithium - ebsteins anomaly Warfarin - frontal bossing, cardiac defects, microcephaly, small nose
62
DiGeorge Syn - ?/CF
chromosome 22 deletion less thymic growth = increased infections cleft palate , cardiac defect
63
Causes of developmental delay - PRE/PERI/POST natal + genetic
Genetic - syndromes/turners/DMD PRE - TORCH/teratogens/ hypothyroid PERI - birth trauma/hypoxia or prematurity POST - brain injury, metabolic disorder
64
Motor Development delay common causes
DMD/Cerebral Palsy, Global Dev Delay e.g downs
65
Cause of speech delay
Familial Deafness Autism Global dev delay
66
What is Short Stature? and what can cause?
more than 2 standard deviations below population mean Normal / intra-uterine insult, downs, achondroplasia, chronic systemic disease, social deprivation
67
Failure to Thrive - ?/ C/ I
poor weight gain in infancy, head circumference preserved as is height. Causes are either: Small family / maternal neglect / feeding technique or could be organic (coeliacs etc) Important to be delicate when assessing for maternal neglect I - bloods for organic causes and assess feeding tech for non-organ
68
Co-morbidities in cerebral palsy:
* Epilepsy * Learning disability * Behaviour problems * Feeding problems / gastro-oesophageal reflux * Osteoporosis
69
Cerebral Palsy - ? / CF
an injury to the brain before, during or after birth. Children with cerebral palsy have difficulties in controlling muscles and movements as they grow and develop.

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