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Year 4 - Paeds > General Paeds > Flashcards

General Paeds Flashcards

1
Q

Neonate fluid requirements

Day 1
Day 5

A

Neonate fluid requirements

Day 1 - 50ml/kg/day
Day 5 - 150ml/kg/day

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2
Q

Paeds Fluid requirements

ml/kg/day

A

Paeds Fluid requirements

> 10kg - 100ml/kg/day
20kg - 50ml/kg/day
<20kg - 20ml/kg/day

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3
Q

Paeds Fluid requirements

5 kg child
15 kg child
25 kg child
50kg child

A

Paeds fluid requirements

5 kg child
= 500ml (5 x 100)

15 kg child
= 1250ml (10 x 100 + 5 x 50)

25 kg child
= 1600ml
[(10 x 100) + (10 x 50) + (5 x 20)]

50 kg child
= 2100ml
[(10 x 100) + (10 x 50) + (30 x 20)]

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4
Q

Working weight
- Measurement

A

Working weight
- Birthweight
- Until Current Weight exceeds

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5
Q

Neonatal disease
- 3 Aetiologies

A

Neonatal diseases

  1. Congenital
  2. Infectious
  3. Nutritional
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6
Q

Neonatal jaundice

  1. Prevalence
  2. Physiology
A

Neonatal jaundice

  1. Prevalence
    - 60% term
    - 80% pre-term
  2. Physiology
    - Excess bilirubin (RBCs)
    - Immature liver
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7
Q

Neonatal Jaundice

  • Pathological aetiologies and causes
A

Neonatal jaundice
- Pathologies

  1. Increased RCB breakdown
    - Extensive bruising
    - Cephalohaematoma
  2. Haemolytic disease
    - Rhesus, ABO
    - G6PD
    - Spherocytosis
  3. Dehydration
  4. Unwell
    - Infection
  5. Prolonged
    - Infection
    - Metabolic
    (hypothyroid, pituitarism, galactosaemia)
    - Breast milk
    - GI
    (Biliary atresia, choledochal cyst)
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8
Q

Physiological jaundice

  • Natural History
A

Natural jaundice history

  1. Starts d2-3
  2. Peaks d5
  3. Resolves d10
  4. Self limiting
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9
Q

Jaundice
- Presentation

A

Jaundice presentation

  1. Colour
  2. Drowsy
  3. Short feeds
  4. Tone/seizures
  5. Unwell (infection, uring output, abdo sign, black stool)
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10
Q

Jaundice
- Ix

A

Jaundice Ix

  1. TCB
    >35/40wk
    > 24 hrs
    <250 micromol
  2. SBR
    <35/40wk
    <24 hrs
    TCB >250micromol
  3. Baby (and mother)
    - Blood group
    - DCT (direct Coombs)
    - FBC
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11
Q

Jaundice
- Tx

A

Jaundice Tx

  1. Phototherapy
    - NICE Threshold Graph
    - Eye protection
    - Check for rebound hyperbilirubinaemia
    - EBM preferred, no additional fluid
  2. Exchange transfusion
    - Encephalopathy
    - ICU
    - Umbilical line (V or A)
  3. IVIG
    - Haemolytic disease
    (rhesus/ABO)
    - Adjunct to phototherapy
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12
Q

Neonatal Jaundice
- Complications

A

Kernicterus from Jaundice

  1. Brain dysfunction
  2. Irreversible grey-matter damage
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13
Q

Perinatal History
- 7 Steps

A

Perinatal History

  1. Anti-natal history
    - All scans ok
  2. Mode of delivery
    - Why c?
  3. Gestation
    - Term?
  4. Birth weight
  5. Resus?
  6. Admission?
    - NNU, SCBU, PNW
  7. When first BO/PU?
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14
Q

Paeds History
- Feeding

A

Paeds Feeding Hx

  1. Enteral vs PN
  2. Breast/bottle
    - EBM
  3. Quality/Regularity/Frequency
    eg. 150mlg/kg/day til weaned
  4. When weaned?
  5. Eating now?
    - 1Y -> Home food
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15
Q

Child Imms
- Timings

A

Child Imms Timings

2mo (Six in one, MenB, Rotavirus)
3mo (6in1, PCV (Pneumo conj), Rota)
4mo (Six in 1, MenB)

1yr (Hib/MenC, PCV, MMR, MenB boost)

3-5yr (DTap/IPV, MMR)

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16
Q

Developmental Timeline

8 Weeks - 5 years

A

Developmental timeline

8 weeks - Embryogenesis

3-9 months - Fetus

22 weeks - 7 days - Perinatal

0-28 days - Neonate

1mo-1 year - Infant

1 year - 3 years - Toddler

3-5 years - Pre-school

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17
Q

Three Trisomies

A

Trisomy conditions

  1. Trisomy 13 (Patau)
    - 1/15,000
    - 80% CHD
  • Holoprosencephaly
  • Cleft lip and palate
  • Microphthalmia / anophthalmia
  • Hypotelorism/cyclops
  1. Trisomy 18 (Edward’s)
    - 1/6,000LBs
    - 8% 1Y survival
    - 90% CHD
  • GI/GU abnormaliites
  • Neurological abnormalities
  • Micrognathia (small jaw)
  • Small facial features/head
  • Cleft lip/palate
  • Overriding fingers
  1. Trisomy 21 (Down)
    - 1/691
    - 50% CHD (AVS 31%+)
    - 5% GI obstruction
  • Brachycephaly with flat occiput
  • Epicanthal folds
  • Uplsanting palpebral fissure
  • Low nasal bridge, low-set ears
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18
Q

Aneuploidies
- Sex chromosome

A

Aneuploidies

  1. 45, X0 (Turner)
    - 1/2500 (detected at puberty)
  • Intelligence normal
  • CHD, IHD, DM, OP
  1. 47, XXY (Klinefelter)
    - 1/660
  • Tall
  • Hypogonadism
  • Sparse hair
  • Gynaecomastia
  • Minor LDs
  1. 47, XYY (Jacob’s)
    - 1/1000
  • No symptoms
  • Tall
  • Low muscle
  • ASD/LD
  1. 47 XXX (Trisomy X)
    - 1/1000
  • No symptoms
  • Tall
  • Curved little finger
  • Epicanthal fold
  • Flat feet
  1. Mosaicism
    - 45, X/ 46, XX
    - 45, X/ 46, XY
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19
Q

Nephrotic syndrome

  1. S&S
  2. Ix
  3. Mx
A

Nephrotic syndrome

  1. Triad
    - Oedema
    - Proteinuria
    - Hypoalbuminaemia
  2. Ix
    - Varicella IgG
  3. Mx
    - Steroid (60mg/m2)
    - Oral pred 4/7
    - Home urine dip
    - Steroid dependence management
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20
Q

Post-strep GN

  1. S&S
  2. Mx
A

Post-strep GN

  1. S&S
    - HTN
    - Haematuria
    - Low C3 complement
    - High ASOT (Antistreptolysin O titre)
  2. Mx
    - Furosemide
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21
Q

Nephritis
- Causes

A

Nephritis causes

  1. Post-infective GN
  2. IgA vasculitis
    - HSP/Henoch-Schonlein Purpura
  3. SLE
  4. MPGN II
    - Membranoproliferative
  5. Vasculitis (ANCA)
  6. Anti-GBM
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22
Q

Safeguarding
- Children’s Acts

A

Children’s Acts

1989 Children’s Act
- Needs of the Child are paramount

2004 Children’s Act
- Statutory Duty

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23
Q

Working together to safeguard children
- Aims
- Years

A

Working together to safeguard children

  • Aims
    1. Keep all safe from harm
    2. Inter-professional working
  • Years
    1. 2006
    2. 2010. 2014, 2018
    3. 2021
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24
Q

Lord Laming Reports
- Focuses

A

Lord Laming Reports

  1. 2003 - Victoria Climbié
  2. 2009 - Baby Peter Connelly
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25
Q

Safeguarding
- When can a baby roll?

A

Safeguarding

  1. Back to front 4-5 months
  2. Front to back 6-8 months
26
Q

Safeguarding
- Bruising

A

Safeguarding
- I can’t move so I can’t bruise
- Ear injuries are non-accidental

27
Q

Under-2 Investigation
- Protocol

A

Under-2 investigation protocol

  1. Skeletal survey (27 films)
  2. CT Head
  3. Ophthalmology
  4. Clotting screen
28
Q

Accidental bruising
- Locations

A

Accidental bruising

  1. Bony prominences (93%)
  2. Front sided
    - Knees
    - Shins
29
Q

Birthmarks

A

Birthmarks

  • Grey slate nevus
    1. 0-4 yo
    2. Buttocks, upper leg, Lower back

Salmon patches
1. 0-2yo
2. Eyelids, head, neck

Haemangioma/strawberry
1. 0-7yo
2. Blood vessels, maybe blue

Port wine stains
1. From birth
2. Face/neck

Cafe-au-lait
1. Common dark patches
2. Anywhere

Congenital mole
1. Cancer risk if large
2. Pigment overgrowth

30
Q

Child development
- Four elements

A

Child development elements

  1. Gross motor
  2. Fine motor and visual
  3. Speech and hearing
  4. Social
31
Q

Development milestones
- Gross motor 6wks - 6mo

A

Gross motor milestones

6wks
- Turn head to both sides
- Lifts head on belly
- Head lag with pull to sit
- Kicking legs and moving arms on back

3-4mo
- No head lag when pulled to sit
- Pushes up on forearms on belly
- Rolls from belly to back

5-6mo
- Rolls from back to belly
- Brings feet to mouth on back

32
Q

Development milestones
- Gross motor 6-12 mo

A

Gross motor 6-12mo

6-8 mo
- Sits alone
- Reaches for toys
- Crawls on belly

9-11mo
- Crawls on hands and knees
- Pulls to standing
- Cruises
- Walks with hands held

11-12-mo
- Walks with one hand held
- Stands along for a few seconds

33
Q

Development milestones
- Gross motor 12-24mo

A

Gross motor 12-24 mo

13-14 mo
- Crawls up stairs
- Stands from floor
- Walks alone

15-18 mo
- Kick a ball
- Run with falling
- Stairs with help

24 mo
- Walks and runs fairly well
- Jumps with both feet
- Stairs alone
- Kicks with either foot

34
Q

Baby Development
- Reflexes

A

Reflex disappearing

2 mo - Stepping, Moro

3mo - Rooting

5-6mo - Palmar grasp, sucking
5-7mo - Tonic neck/fencing

9-12 - Plantar grasp

35
Q

Speech and hearing

  1. Screen
  2. Development
A

Speech and hearing

  1. Day 1/day 2 screening hearing
  2. 3mo making sounds
36
Q

Tonsillectomy

  • Criteria
  • Post-op
A

Tonsillectomy

  • Criteria
    4 x 3 years
    5 x 2 years
    7 x 1 year
  • Post-op
    1. Food and fluids
    2. Sats Monitoring
37
Q

Neonatal Thrombocytopenia levels
1. Normal
2. For procedure
3. For transfusion

A

Neonatal Thrombocytopenia

150 - Normal
75 - For procedure
50 - For transfusion

38
Q

NAS
- S&S
- Management

A

Neonatal abstinence syndrome

  • S&S
    1. Continuous cry
  1. Tachypnoea
  2. Restlessness
  3. Scratching
  4. Tremor
  5. Hypertonia
  6. Difficulty feeding
  7. D/V
  8. Fever
  9. Convulsions

Mx
1. HepB Vaccine
2. Lipsitz score
3. Oral morphine
4. Phenobarbital

39
Q

Fontanelles
- Five bones of cranium

A

Cranium

  1. Frontals
  2. Parietals
  3. Occipital
40
Q

Anterior fontanelle
- Borders

A

Anterior fontanelle

  1. L/R Frontal
    - Metopic suture
  2. L/R Parietal
    - Sagital suture
  • Coronal suture
41
Q

Fontanelles
- Closure timeline

A

Fontanelle closure
- Intramembranous ossification

  1. Anterior
    - 13-24 months
    - Males before females
  2. Posterior
    - 6-8 weeks
42
Q

Fontanelle associations
- Large
- Delayed closure

A

Large fontanelle conditions

  1. T21
  2. Achondroplasia
  3. Congenital hypothyroidism
  4. Rickets
    5.Raised ICP
43
Q

Neonate
- Dehydration signs

A

Neonatal dehydration

  1. Sunken fontanelle
  2. Dry membranes
  3. Sunken eyes
  4. Poor tears
  5. Peripheral perfusion
  6. Dry diapers
44
Q

Bulging anterior fontanelle
- Conditions

A

Bulging a. fontanelle

  1. Raised ICP
  2. Hydrocephalus
  3. Hypoxemia
  4. Meningitis
  5. Trauma
  6. Haemorrhage
45
Q

Posterior fontanelle
- Borders

A

Posterior fontanelle

  1. Parietal lobes
  2. Occipital lobe
    - Lambdoid suture
46
Q

Posterior fontanelle
- Delayed closure

A

Open p. fontanelle
- 8+weeks

  1. Hydrocephalus
  2. Hypothyroid
47
Q

Mastoid fontanelle
- Borders
- Closure

A

Mastoid fontanelle (x2)
- Anterolateral

  • Borders
  1. Parietal
  2. Temporal
  3. Occipital
  • Closure
    1. 6-18 months
48
Q

Sphenoid fontanelle

  • Borders
  • Closure
A

Sphenoid fontanelles (x2)

Borders
1. Frontal
2. Parietal
3. Temporal
4. Sphenoid

Closure
- 6 months

49
Q

Third fontanelle

  • Epidemiology
A

Third fontanelle

  1. 6%
  2. Associations
    - T21
    - Rubella
50
Q

B symptoms
- Origin
- Examples

A

Symptoms

  • Origin
    1. Ann Arbour Grading
    2. Lymphoma
  • B Symptoms
    1. Fever
    2. Night sweats
    3. Weight loss (10%/6mo)
51
Q

Haemolysis
- Causes

A

Haemolysis DDx

  1. Autoimmune
    - Cold agglutinin-mediated (IgM)
    (M. pneumonia/EBV/mumps/CMG)
    - Warm agglutinin-mediated (IgG)
    (HIV, Hep C, Mono)
    - Paroxysmal cold haemoglobinuria (IgG)
    (URTI, chickenpox, mono)
  2. Infectious
    - Malaria
    - C. perfringens
  3. Haematological
    - MAHA
    (TTP, HUS, DIC)
  4. Congenital
52
Q

Haemolysis
- Ix

A

Haemolysis Ix

  1. Reticulocytes
    - Low = Anaemic
  2. Smear
    - Schistocytes = destruction
  3. (+)LDH and (-)Haptoglobin
    - Destruction/haemolysis
  4. INR, PT, aPPT, fibrinogen
    - Affected by DIC, not HUS/TTP
53
Q

Paeds
- General examination

A

Paeds general exam

  1. Demographic
  2. Succinct development
    - eg. GM normal for age
  3. HPC
    Eg. RDS
    - SVIA/HFNC
    - Good cry
    - Intra/subcostal recessions
    - Grunting/Tracheal tug/Nasal flare
54
Q

Febrile Seizure
- Pres
- Mx

A

Febrile Seizure

  • Pres
    1. 6mo-5yo
    2. 38º
    3. Male
    4. 3-5 min seizure, rapid recovery
  • Mx
    1. CBG
    2. R/O Meningitis/Encephalitis
  • ?LP
    3. Electrolytes if vomiting/ketotic
  • Ca, P, Mg
  1. Fever management
    - Para/Ibu
  2. Status management
    - Midazolam
    - Phenytoin
55
Q

Floppy Baby

  1. Pres
  2. Aetiologies
A

Hypotonia

  • Pres
    1. Transient in newborn
  • Not severe
    2. Profound/persistent
  • Causes
  1. Acutely unwell child
  2. Central
    - Chromosomal/Genetic
  3. Spinal
    - Cord Injury/Ischaemia
    - SMA (spinal muscular atrophy)
  4. Polyneuropathies
  5. NMJ
    - Transitory myasthenia
    - Familial infantile myasthenia
  6. Myopathy
    - Muscular dystrophies
    - Myotonic dystrophies
56
Q

Floppy Baby

  1. Ix
  2. Mx
A

Hypotonic infant

  • Ix
  1. HF exam
  2. Organomegaly
  3. Temperature/septic screen
  4. AVPU
  5. HIE assessment
  6. Genetic testing
  • Mx
  1. Bedside
    - Airway management
    - Resp and feeding support
    - VBG
    - Hx and Ex
  2. Bloods
    - FBC, U&E, Glucose, Electrolytes, TFTs
    - CRP + Culture
    - CSF
  3. Imaging
    - USS
  4. Special tests
    - Urine AAs
    - Urine GAGs
    - EEG
57
Q

Childhood gait
- Ten Differentials

A

Childhood gait DDx

  1. NAI
    - <12mo
    - Inconsistent
  2. Toddler’s fracture
    - Spiral tibia
  3. Septic arthritis
    - <10yo (3-7)
    - Sudden-onset hip
    - Fever
  4. DDH
    - 12-24mo
    - First-born breech females
    - Barlow’s/Ortolani’s
  5. Perthes
    - 4-10yo
    - Weeks/days
  6. Osgood-Schlatter
    - Older child after activity
    - Active growth
  7. JIA
    - Oligo (pre-school, girls)
    - Poly (older,girls)
  8. SCFE
    - 11-15yo, boys
    - obesity, hypothyroid, delayed 2º sexual
  9. CP
  10. Muscular distrophies
    - Boys, delayed walking
    - Family history
58
Q

Muscular dystrophies

  • Epidemiology
  • Pathophysiology
A

Muscular dystrophies

  • Epidemiology
    1. DMD most common
  • 1/3000 male births
  • 2/3 x-linked
    2. Becker MD
  • 1/25,000
  • Pathophysiology
    1. Dystrophin protein deficiency
    2. Muscle fibre necrosis
    3. Rapidly progressive dystrophy
    • More common than hypotonia at birth
  • Delayed motor milestones
59
Q

Muscular dystrophies
- Staging
- Mx

A

Muscular Dystrophies

Stage 1 - Ambulatory
1 Psychological support
2 PT
- Muscles
- Contractures (CSTs, surgery)
3 Glucocorticoid therapy
- Muscle strength and function

Stage 2 - Non-ambulant
1 ADLs
- Vehicles
- Computers
2 Nutrition
- Swallow (PEG/RIG)
- Tachypnoea
3 Scoliosis prevention

Stage 3 - Ventilator-supported
1 Muscle rest
- IPPV
- MAC (mechanically-assisted-coughing)
- Support

60
Q

Paediatric oedema
- 10 General Causes

A

Generalised paeds oedema

  1. Nephrotic
  2. CKD
  3. CHD
  4. Protein-losing enteropathy
  5. CF
  6. Malnutrition
  7. Refeeding
  8. Water overload
  9. SIADH
  10. Hypothyroid
61
Q

Paediatric oedema
- 10 Localised causes

A

Localised paeds oedema

  1. Infections/bites
  2. Trauma
  3. Henoch-Schonlein P (HSP)
  4. Graves’
  5. Juvenile dermatomyositis
  6. Venous obstruction
  7. PD
  8. Lymphoedema

Year 4 - Paeds (11 decks)

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