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Paeds > Gen Medicine > Flashcards

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
Q

What is hyaline mebrane disease?

A

respiratory distress syndrome

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26
Q

Forms of bowel obstruction in Paeds?

A
  • Intussuseption
  • incarcerated hernia
  • volvulus
  • post-op adhesions
  • mesocolic hernia
  • meckel diverticula
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27
Q

What is intussuseption

A

large loop of bowel surrounding smaller loop providing pouch for collecting faeces.

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28
Q

Neonatal Jaundice - Causes (both types)/ I/ CF/ T

A 
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
Q

Most likely cause of jaundice >14 days

A

sepsis, breastfeeding, hypothyroid, Cystic Fibrosis

30
Q

Side effects of treatment (phototherapy and exchange transfusion)

A

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
Q

What is hyperbilirubinaemia (rough level)

A

over 200 mmol/L bilirubin

32
Q

What might be seen in a neo-nate with neonatal cyanosis?

A

Blue discolouration of mucous membranes +/- skin

33
Q

What might cause nnnneo-natal cyanosis?

A

any cause of respiratoooory distress

  • persistant pulomnary hypertension of newborn
  • congenital cyanotic heart disease
  • tracheo-oesophageal fistula
  • diaphragmatic fistula
34
Q

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?

A

tachypnoa, rib recession, nasal flaring, grunting

  • Auscultation heart (congenital heart)
  • Assess Abdomen (diaphragmatic herna)
35
Q

What investigations should be done for a child with neonatal cyanosis?

A

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
Q

How to treat neonatal cyanosis?

A

ABC approach, then establish an airway and start O2 +/- ventilation
Gain IV access and draw bloods

If Sepsis suspected start antibiotics broad spectrum.

37
Q

What is the most common cause of delay/failure to pass meconium?

A

Hirschprungs Disease

38
Q

What is hirschprungs disease?

A

congenital absence of ganglia in a segment of colon - this leads to difficulty passing stool

39
Q

CF of Hirschprungs disease / RF / I and DDx

A

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
Q

How to treat hirschprungs disease?

A

Bowel Irrigation + surgical excision of the affected area +/- colostomy

41
Q

What is respiratory distress of the neo-nate?

A

this is insufficient surfactant resulting in the lungs inability to stayyyyy expanded. This causes the the baby to fatigue and possibly die.

42
Q

What is the risk of respiratory distress in press at 24-28 weeks and 32+ weeks?

A 
24-28 = 100%
32+ = 50%
43
Q

main RF for respiratory distress?

A

Premature birth, Fam Hx, hypothermia, maternal DM

44
Q

response Distress : CF / I /DDx / T

A

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
Q

What is used to guess severity or resp distress?

A

the more premature the baby, the worse the prognosis.

also if hypoxia occurs refractory to treating it is not survivable.

46
Q

What can respiratory distress lead to if survived?

A

chronic lung diseases (bronchopulmonary dysplasia)

47
Q

In what ways and at what time can congenital abnormalities be detected?

A

Antenatally (USS 18-20 weeks)
At Birth
Routine neo-natal exam
Later in life

48
Q

Causes of Congenital Abnormalities?

A

chomosomal abnormalities (downs/turners), secondary to intra-uterine infection, due to teratogens, assoc with other syndromes

49
Q

CNS Congenital Abnormalities

A

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
Q

ENT Congenital Abnorm (CF,C,T)

A

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
Q

GI congenital abnormalities (CF,C,T)

A
  • 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
Q

GUM congenital abnormalities (CF,C,T)

A
  • 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
Q

Respiratory congenital abnormality (how found/ CF/ prognosis)

A

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
Q

MSK Congenital Abnorms (?/ inheritance pattern/ CF) + name of others covered elsewhere

A

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
Q

DOWNS (?/ RF/ I/ CF/ assoc diseases/ seen on exam)

A

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
Q

Other Chromosomal Abnorm (?/ CF)

A

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
Q

What are the TORCH infections

A 
Toxoplasmosis
Other (syphilis)
Rubella
Cmv
HSV
58
Q

ToRCH infections (spread, CF)

A

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
Q

Congenital Abnorm due to Teratogens - common causes

A

Alcohol, phenytoin, sodium valproate, lithium, warfarin, tetracycline

60
Q

Foetal Alcohol - CF + assoc

A

Microcephaly, hypoplastic upper lip, absent philtrum, small eyes, epicanthic folds

decreased IQ and cardiac defects are common

61
Q

CF’s teratogen
Phenytoin
Lithium
Warfarin

A

Phenytoin - cleft lip/palate, cardiac defects, hypoplastic nails, crano-facial abnorms

Lithium - ebsteins anomaly

Warfarin - frontal bossing, cardiac defects, microcephaly, small nose

62
Q

DiGeorge Syn - ?/CF

A

chromosome 22 deletion
less thymic growth = increased infections
cleft palate , cardiac defect

63
Q

Causes of developmental delay - PRE/PERI/POST natal + genetic

A

Genetic - syndromes/turners/DMD
PRE - TORCH/teratogens/ hypothyroid
PERI - birth trauma/hypoxia or prematurity
POST - brain injury, metabolic disorder

64
Q

Motor Development delay common causes

A

DMD/Cerebral Palsy, Global Dev Delay e.g downs

65
Q

Cause of speech delay

A

Familial
Deafness
Autism
Global dev delay

66
Q

What is Short Stature? and what can cause?

A

more than 2 standard deviations below population mean

Normal / intra-uterine insult, downs, achondroplasia, chronic systemic disease, social deprivation

67
Q

Failure to Thrive - ?/ C/ I

A

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
Q

Co-morbidities in cerebral palsy:

A
  • Epilepsy
  • Learning disability
  • Behaviour problems
  • Feeding problems / gastro-oesophageal reflux
  • Osteoporosis
69
Q

Cerebral Palsy - ? / CF

A

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.

Paeds (12 decks)

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