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paediatrics > General Paeds > Flashcards

General Paeds Flashcards

1
Q

what age should you refer if the child isnt walking?

A

18 months

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2
Q

what happens at the 6-8 weeks review?

A

Identification data (Name, address, GP)

Feeding (breast/ bottle/ both)

Parental concerns (appearance, hearing; eyes, sleeping, movement, illness, crying, weight)

Development (gross motor, hearing + communication, vision + social awareness)

Measurements (Weight, OFC, Length)

Examination (heart, hips, testes, genitalia, femoral pulses and eyes (red reflex))

Sleeping position (supine, prone, side)

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3
Q

healthy child programme

A

antenatal

birth - 1 week after

2 weeks

6-8 week review

1 year

2-2.5 years

5 years

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4
Q

how do you monitor physical growth in a child?

A

weight (grams and kgs)

length or height

head circumference

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5
Q

causes of failure to thrive in early life:

maternal

A

deficiency intake:

poor lactation

incorrectly prepared feeds

unusual milk or other feeds

inadequate care

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6
Q

causes of failure to thrive in early life:

infant

A

prematurity

small for dates

oro-palatal abnormalities (cleft palate)

neuromuscular disease

genetic disorders

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7
Q

causes of failure to thrive in early life:

increased metabolic demands

A

congenital lung disease

heart disease

liver disease

renal disease

infection

anaemia

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8
Q

causes of failure to thrive in early life:

excessive nutrient loss

A

gastro-oesophageal reflux

pyloric stenosis

gastroenteritis

malabsorption (food allergy, coeliac disease, persistent diarrhoea etc)

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9
Q

non medical causes of failure to thrive:

A

poverty/ socio-economic status

dysfunctional family interactions

difficult parent child interactions

lack of parental support (no family etc)

lack of preparation for parenting

emotional deprivation

child neglect

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10
Q

Primary care assessment tools when looking at children with special needs:

(know these!)

A

ASQ (ages and stages questionnaire)

PEDS (parents evaluation of development status)

M-CHAT (checklist for autism in toddlers)

SOGS-2 (schedule of growing skills)

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11
Q

William’s syndrome:

A

broad forehead

flat nasal bridge

short nose

full lips

wide mouth

aortic stenosis

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12
Q

What are some red flag signs a child may have a developmental syndrome?

A

loss of developmental skills

vision problems

hearing problems

floppiness

no speech by 18-24 months

asymmetry of movement

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13
Q

CASE 1

vomiting baby - what questions do you ask?

A

what does he weight?

what are his feed volumes?

what are his feed volumes/ how many per day?

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14
Q

common cause of baby vomiting and unsettled

A

overfeeding!

normal should be 120-140ml (4-5oz per feed)

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15
Q

what units do you measure children’s weight in?

A

kilograms and grams

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16
Q

how much is an ounce?

A

1/16th of a pound

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17
Q

A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ

Diagnosis?
Additional features of the history/ examination?
Management?

A

Diagnosis
Constipation +/- impaction

History
Stool frequency/ consistency/ size/ pain/ blood
Toilet training and use/ Soiling/ Withholding
Diet/ appetite/ fluids/ activity/ school routine

Examination
Inspect lower spine and anus
Check lower limb neurology
Measurements and centile
No rectal examination
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18
Q

constipation cycle:

A

pain or anal fissure

withholding of stool

constipation

large hard stool

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19
Q

how do you treat constipation in a child?

A

stool softeners/stimulants (senna, lactulose, movicol)

increase fluid intake

fruit, veg, fibre

reduce milk/ sweets

toilet routine and comfort

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20
Q

A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees).
Examination showed a soft abdomen with no palpable masses.

Diagnosis and differential?
Other questions to ask?
Management and investigations?

A

Diagnosis and differentials:

Gastro-oesophageal reflux (GORD) (common in babies)

+/- Milk intolerance

Consider pyloric stenosis

Consider surgical causes if bilious

Other questions

Vomits: Bilious or not/ Volume/ Amount/ Blood

Feeding: Type/ Volume/ Frequency/ Position

General: Weight gain+ centiles/Development/ Cough

21
Q

how do you manage GORD?

A

feeding advice (routine/ volumes/ reassurance)

medical (feeding thickeners - gaviscon), milk free feeding, acid reduction

surgery (uncommon - gastrostomy)

22
Q

GORD is very common in

A

babies

23
Q

GORD in babies is usually

A

self limiting

24
Q

2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen

Diagnosis?

A

Diagnosis (differentials)

Coeliac disease!

25
Q

2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen

investigations?

A

Coeliac serology

stool screen (culture, feacal elastase, electrolytes)

small bowel biopsy (duodenal)

IgA

26
Q

2y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day)+ flatus, miserable. Picky eater, all normal diet, formula fed, tried milk free diet- no benefit.
No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen

treatment?

A

gluten free diet

27
Q

A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination

(green vomit)

differentials?

A

this is bilious vomiting!! (should ALWAYS ring alarm bells!)

(due to intestinal obstruction until proven otherwise)

Causes:

malrotation

intussusception (usually older - in infants or toddlers)

crohn’s

intestinal atresia (newborns)

28
Q

intestinal atresia only happens in

A

new borns

29
Q

intussusception usually occurs in

A

older infants and toddlers

30
Q

A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination

(green vomit)

management?

A

urgent surgical opinion

IV access

IV fluids

NG tube

(nothing by mouth)

31
Q

A 2 week old baby present with a 2 day history of vomiting all feeds. The parents bring in one of his baby grows. Weight is down 30g.
He is unsettled on examination

(green vomit)

investigations:

A

abdominal x-ray

contrast meal

32
Q

A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o

diagnosis?

A

bronchiolitis

33
Q

A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o

investigations?

A

nasopharyngeal aspirate

34
Q

A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough.
Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o

management

A

no proven role for any meds

Observation!

35
Q

what is the most common LRTI?

A

bronchiolitis

36
Q

symptoms of bronchiolitis

A

tachypnoea

poor feeding

nasal stuffiness

37
Q

An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o

differentials?

A

Most likely is croup (laryngotracheitis)

foreign body

epiglottitis

38
Q

An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o

management?

A

calm and avoid stress/ anxiety

oral steroid (dexamethasone, prednisolone)

39
Q

symptoms of croup

A

child is usually WELL

barking cough!

hoarse voice

stridor

coryza ++

40
Q

symptoms of epiglottis

A

stridor

DROOLING

41
Q

how do you treat epiglottis?

A

intubation and antibiotics

42
Q

how do you treat croup?

A

oral steroids

43
Q

A 3y old girl presents with a 4 day history of increasing lethargy, cough, fever and tummy pain. She has vomited x4 in the last 2 days.
Examination showed temp 39.8o, resp rate 40, nasal flaring, intercostal recession, no focal chest findings, RUQ discomfort, soft abdomen.

Diagnosis and differential?

A

LRTI (is it right lower lobe penumonia!)

UTI

appendicitis

44
Q

A 3y old girl presents with a 4 day history of increasing lethargy, cough, fever and tummy pain. She has vomited x4 in the last 2 days.
Examination showed temp 39.8o, resp rate 40, nasal flaring, intercostal recession, no focal chest findings, RUQ discomfort, soft abdomen.

Investigation and management?

A

check saturations

consider CXR so confirm signs

urine dipstick/ culture

Manage: oral amoxicillin or macrolide

45
Q

pneumonia symptoms

A

fever

SOB

cough

grunting

46
Q

if a child has a wheeze- what is less likely cause of it?

A

a bacterial infection

47
Q

what bacteria are responsible for pneumonia?

A

pneumococcus

mycoplasma

chlamydia

48
Q

What does HEADSS stand for in adolescent psychosocial interview

A

Home and environment

education and employment

activities

drugs

sexuality

suicide/ depression

paediatrics (37 decks)

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