General Paeds Flashcards
What is reflex anoxic seizures?
Syncopal episode followed by brief clonic movements that occurs in response to pain or emotional stimuli.
Caused by vagal induced brief cardiac asystole.
Seen in children aged 6m-3y.
What are the features and treatment for reflex anoxic seizures?
Presentation - Child goes very pale, falls to floor, may have seizure and then reapid recovery.
No specific treatment as prognosis excellent.
Explain breath holding in babies and children?
Described as an episode of breath holding (up to 1 minute) associated with painful, fearful or unpleasant stimulus.
Child may turn pale/blue, be floppy or stiff and may faint.
Should stop when baby is aged 4-5 years.
What is bronchiolitis?
Acute bronchiolar inflammation commonly caused by RSV.
Most common cause of serious LRTI in kids < 1 year old, more common in winter.
More serious if premature baby, congenital heart disease or cystic fibrosis.
What are the features of bronchiolitis?
coryzal symptoms,
Dry cough,
Increasing breathlessness,
Wheezing, fine inspiratory crackles,
Feeding difficulties.
When do you immediately refer a child with bronchiolitis to hospital?
Apnoea,
Child looks seriously unwell,
Severe respiratory distress eg, grunting, chest recession or resp rate > 70.
Central cyanosis.
O2 sats persistently less than 92%
What are the risk factors for bronchiolitis?
Age < 12 weeks of life.
Chronic lung disease,
Congenital heart disease,
Prematurity < 32 wks.
Immunodeficiency
Neuromuscular disorders
What is the management of bronchiolitis?
Mainly supportive!
Humidified oxygen via head box if O2 sats below 92%.
NG feed if feeding issues
Suction for upper airway secretions.
Signs of respiratory distress in paeds? IMPORTANT
Increased respiratory rate.
Use of accessory muscles - SCM, intercostal and abdominal muscles.
Intercostal/subcostal recessions.
Nasal flaring.
Head bobbing with breathing.
Tracheal tugging.
Cyanosis.
Abnormal airway noises.
Features of cellulitis in children
Different types - erysipelas, impetigo, bites, paronychias (sides of fingernail folds), nec fasciitis.
Treatment - Drainage, flucloxacillin. Add clindamycin if significant concern.
What are the causes of constipation in children?
Combination of painful defecation, hard stools due to low fibre, poor nutrients, anal fissure, hirschsprung’s disease and dehydration.
Occasionally can be caused by delated colonic motility
What is the definition of conspitation?
Infrequent passage of stools leading to one or more of following:
Painful defecation,
Overflow incontinence,
Rectal faecal impaction
Active defecation avoidance behaviour
What are the presenting features of constipation in children?
Painful/difficult defecation.
Long intercals between stools,
Fecal incontinence,
Abdominal pain,
Abdominal distention,
Palpable faecal mass per abdomen,
Otherwise healthy
What are the red flag symptoms of constipation suggesting underlying disorder
Constipation reported from birth/first few weeks of life.
Passage of meconium > 48 hours
Faltering growth
Undiagnosed leg weakness,
Distension
Signs of fecal impaction?
Symptoms of severe constipation,
Overflow soiling,
Fecal mass palpable in abdomen (DRE only done by expert)
Management of constipation if fecal impaction is present?
First line = Movicol paediatric plain (Polyethylene glycol 3350 and electolytes).
Add stimulant if movicol paedicatric plain hasn’t worked within two weeks or if not tolerated.
What is the maintenance therapy for constipation?
First line - Movicol paediatric plain.
Add stimulant if no response or not tolerated.
Continue meds for several weeks after regular bowel habit established then reduce dose gradually.
Management of constipation in infants not yet weaned
Bottle fed - give extra water in between feeds. Abdominal massage and bicycling infants legs.
Breast fed - unusual and orgnaic cause should be considered
What are the causes of faltering growth?
Inadequate caloric intake (environmental factors, poor appetite, feeding problems).
Increased calorific demand (infections, surgery or chronic illnesses).
Excess caloric loss (persistent vomiting, pyloric stenosis),
Inefficient use of calories (GI disorders, endocrine disorders)
Investigations for faltering growth?
Blood screen: FBC, U&Es, LFTs, TFTs, bone profile, CRP +/- coeliac screen
What are febrile convulsions and their presentation?
Seizures provoked by fever in otherwise normal children. Typically occur in children aged 6months - 5 years.
Presentation - early in viral infection, breif seizure which is commonly clonic tonic.
Definition of simple febrile seizure
Fever and all of following - <15mins, generalized tonic clonic seizure, no recurrence in same febrile illness, completely recovered in hour.
Definition of complex febrile seizure
Fever and any of the following: Focal features at onset/duration of seizure, duration > 15mins, incomplete recovery in 1hr and recurrence within same febrile illness.
Afebrile febrile seizure
Seizure in an acute infectious illness without documented fever.
Features consistent with simple febrile seizure.
What is the management of febrile convulstions?
Admit to hospital - first seizure or complex seizure.
Ongoing management - tell parents to phone ambulance if seizure > 5mins. If recurrent then benzodiazepines rescue medication.
Antipyretics do not reduce chance of febrile seizure occuring as they are not absorbed fast enough.
