ILAs/MISC Flashcards
What vaccines are given at 8 weeks old? (9)
Diptheria/Tetanus/Pertussis/Polio/Haemophilus influeunzae type B/Hepatitis B
Pneumococcal (PCV)
Meningococcal group B
Rotavirus gastroenteritis
What vaccines are given at 12 weeks old? (7)
Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B
Rotavirus
What vaccines are given at 16 weeks old? (8)
Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B
Pneumococcal (PCV)
Meningococcal group B
What vaccines are given at 1 year old? (7)
Hib/Meningococcal group C
Pneumococcal (PCV)
Measles, mumps, rubella (MMR)
Meningococcal type B
What vaccines are given at 3 years 4 months? (5)
Diptheria, tetanus, pertussis and polio
MMR
What vaccine is given to girls age 12/13?
Human papillomavirus (HPV)
What is given at 14 years? (7)
Tetanus, diptheria, polio
Meningococcal A C W Y
Other vaccines that may be given? (3)
Paediatric flu vaccine
Tuberculosis if high risk - at birth
Additional pneumococcal/flu/hepatitis vaccines for those with conditions such as diabetes, CKD, haemophilia, immunosuppression, sickle cell
What are developmental milestones? What are the 4 groups?
Acquisition of important developmental skills Gross motor Vision and fine motor Hearing, speech, language Social, emotional, behavioural
What is the moro reflex?
Sudden extension of the head causes symmetrical extension then flexion of the arms
What is the grasp reflex?
Flexion of fingers when object placed in palm
What is the rooting reflex?
Head turns to the stimulus when touched near the mouth
What is the stepping reflex?
Stepping movements when held vertically and dorsum of feet touch a surface
What should a newborn development be?
Limbs flexed, symmetrical posture
Marked head lag on pulling up
Gross motor development? 4 with ages
Head control - 3 months
Sits unsupported - 6-8 months
Stands - 10 months
Walks - 12 months (worrying if not by 18)
Fine motor/vision development? 4 with ages
Fixes and follows - 6 weeks
Reaching - 4 months
Transferring - 7 months
Pincer grip - 10 months
Hearing/speech/language development? 3 with ages
Vocalises alone - 3-4 months
Mama/dada - 6-9 months
3 word sentences - 2 years
Social/behaviour development? 4 with ages
Smiles - 6 weeks
Food in mouth - 6-8 months
Feeds self - 18 months
Interactive play - 3 years
When should a child be able to make a tower of 3-4 bricks?
18 months
When should a child be able to make a tower of 6-8 bricks?
2/2.5 years
When should a child be able to build a brick bridge?
3-3.5 years
When should a child be able to draw a line, circle, square?
Line - 2-2.5
Circle - 3-3.5
Square - 4-5
What 6 things are included in a septic screen?
Bloods (FBC, CRP/ESR, U+E, blood gas) Blood cultures Urine dipstick and MC+S Stool sample Chest X ray Lumbar puncture (protein, glucose, MC+S, gram stain)
What is seen on lumbar puncture in bacterial infection vs viral?
Bacterial - elevated opening pressure, turbid CSF, high WCC, positive gram stain, high protein, low glucose
Viral - normal opening pressure, clear fluid, low WCC, negative gram stain, normal/high protein, normal/low glucose
What does a septic screen screen for?
Severe infection and systemic inflammation
Dose of cefotaxime for meningococcal septicaemia?
2g IV
Diagnosis of Kawasaki disease?
Fever + 4/5 of My HEART Mucosal involvement - lips, mouth Hand/foot redness, swelling, peelin Eye conjunctivitis Adenopathy (lymph) Red rash Temperature >5 days
What is Reye’s syndrome?
Can be caused by aspirin in kids
Brain and liver disease - vomiting, fits, tiredness, confusion
Side effects of IV immunoglobulin?
rare - anaphylaxis
headache, nausea, wheezing/chest tightness
Complications of Kawasaki disease?
CV disease - aneurysm, heart disease, MI
How to work out maintenance fluid dose?
4ml per kilo first 10kg
2ml per kilo second 10kg
1ml per kilo after that
27kg would be 40 + 20 + 7 = 67ml hourly
67 x 24 = 1608ml daily 0.9% sodium chloride
How to correct fluid deficit for dehydration?
Dehydrated - 50mls/kg extra
Shocked - 100mls/kg extra
OVER 24 HOURS
Fluids for a 12kg girl 5% dehydrated?
Maintenance 44ml hourly x24 = 1056ml daily
Dehydrated = 50ml/kg extra over 24 hours
50 x 12 = 600
1056 + 600 = 1656ml
Signs of dehydration in children? (6)
Appears unwell Irritable Decreased urine output Sunken eyes Dry mucous membranes Reduced skin turgor Slightly prolonged cap refill time
Signs of shock? (8)
Decreased level of consciousness Pale/mottled skin Cold extremities Prolonged capillary refill time Hypotension Tachycardia Tachypnoea
What is usual fluid bolus given in dehydration? Exceptions?
20mls/kg 0.9% sodium chloride
If trauma or diabetic ketoacidosis give 10mls/kg
What 9 conditions are in the newborn blood spot screening test?
sickle cell disease (SCD) cystic fibrosis (CF) congenital hypothyroidism (CHT) phenylketonuria (PKU) medium-chain acyl-CoA dehydrogenase deficiency (MCADD) maple syrup urine disease (MSUD) isovaleric acidaemia (IVA) glutaric aciduria type 1 (GA1) homocystinuria (pyridoxine unresponsive) (HCU)
Dose of thyroxine for congenital hypothyroidism?
10-15mcg a day per kg
Differentials of a sick neonate?
Trauma, tumour, thermal Heart disease, hypovolaemia, hypoxia Endocrine - CAH, DM, thyroid Metabolic disturbance - electrolytes Inborn errors of metabolism Seizures of CNS metabolism Formula dilution or over concentration leading to hypo/hypernatraemia Intestinal catastrophe (NEC, volvulus, intussusception) Toxins Sepsis
Can congenital adrenal hyperplasia be treated antenatally?
Give dexamethasone to reduce virilisation
Biochemical presentation of a salt losing crisis?Management?
LOW SODIUM HIGH POTASSIUM
METABOLIC ACIDOSIS
Saline, dextrose, hydrocortisone IV
Management of CAH?
Hydrocortisone lifelong (glucocorticoid), additional if illness or injury Fludrocortisone (mineralocorticoid) if salt wasting
Characteristics of respiratory acidosis on ABG?
Low pH
High CO2
Causes of respiratory acidosis?
Respiratory depression
Asthma
COPD
Characteristics of respiratory alkalosis ABG?
High pH
Low CO2
Causes of respiratory alkalosis?
Hyperventilation - pain, anxiety, hypoxia
Characteristics of metabolic acidosis on ABG?
Low pH
Low HCO3
Low base excess
Causes of metabolic acidosis?
Increased acid production - diabetic ketoacidosis Decreased acid excretion - addisons disease
Loss of HCO3 - diarrhoea
Characteristics of metabolic alkalosis on ABG?
High pH
High HCO3
High base excess
Causes of metabolic alkalosis?
Vomiting/diarrhoes
Renal loss - diuretics, heart failure
How are respiratory acidosis/alkalosis compensated?
Metabolically - by increasing or decreasing the levels of bicarb to correct pH
How are metabolic acidosis/alkalosis compensated?
Respiratory - retaining or blowing of CO2 to correct pH
What would respiratory acidosis with metabolic compensation look like on ABG?
Low pH
High CO2
High HCO3!
What would respiratory alkalosis with metabolic compensation look like on ABG?
High pH
Low CO2
Low HCO3!
What would metabolic acidosis with respiratory compensation look like on ABG?
Low pH
Low HCO3
Low CO2!
What would metabolic alkalosis with respiratory compensation look like on ABG?
High pH
High HCO3
High CO2!
Murmur in ASD?
EJECTION SYSTOLIC murmur UPPER LEFT sternal edge
Murmur in VSD?
Harsh PANSYSTOLIC murmur LOWER left sternal edge
Murmur in PDA?
CONTINUOUS murmur UPPER left sternal edge
How is RDS managed?
Surfactant through TRACHEAL TUBE
Airway + breathing - clear if needed, high flow humidified oxygen/CPAP/mechanical ventilation
Incubator
Neonatal antibiotics for suspected infection?
Benzylpenicillin and gentamicin
Why do preterm infants get hypoglycaemia and how is it managed?
Poor glycogen stores
Prevention - early frequent milk feeding
Dextrose IV given
NG feeding
Risk of building up fluids too quickly in neonates?
NEC! reflux, aspiration
How is adequacy of nutrition monitored in paeds?
Input/output fluid chart
Weight