Important ILA Points Flashcards
What makes up a septic screen?
- Urinalysis
- Bloods (FBC, CRP, U&E)
- Blood cultures
- Lumbar puncture
What is the definition of sepsis?
Inappropriate systemic response to infection that leads to end organ dysfunction
What are serious bacterial infections in kids?
- UTI
- Meningitis
- Pneumonia
- Bacteraemia
What would results of CSF be in meningococcal septicaemia?
- High neutrophil count
- No red cells
- Low glucose
- High protein
Why may a child with meningococcal septicaemia present in acidosis?
They are tachypnoeic
Why might you restrict fluids in a child with meningitis?
If they have raised ICP
What would you do if you had given a child with meningitis two boluses and they were still not getting any better
IV inotropes
Call PICU
What antibiotic treatment would you give a 1 year old child with meningitis?
IV Ceftriaxone
IV Amoxicillin
What causes purpura in meningitis?
N. meningitidis releases endotoxins which active factor VII, causing DIC
Would you fluid restrict a child that presented with meningitis?
NO
What antibiotics would you give close contacts?
Rifampicin
What treatment do you start kids on if they have JIA?
NSAIDS
What do you give in JIA if the child still has symptoms after first line treatment?
Steroid injections
Immunosuppressants - methotrexate / etanercept
What is the criteria for Kawasaki’s?
BURN (>38 for 5 days) Conjuntivitis Rash - trunk and extremities Adenopathy - cervical Strawberry tongue Hands - oedema erythema
When do you reduce the dose of aspirin in Kawasaki?
When the fever is gone
What two drug treatments do you give in Kawasaki’s?
- Aspirin
2. Gamma globulin (STAT)
What investigation is key in Kawasaki’s?
ECHO - initial and 6 week
What syndrome can aspirin cause?
Reye’s - liver and brain damange
What happens cardio wise in Kawasaki?
Inflammation of vessels which leads to formation of aneurysms. May heal but may thrombus and cause MI
What would a blood gas show in DKA?
Metabolic acidosis
What tests do new diabetics need to have (3)?
- Thyroid
- Coeliac
- Haemoglobin
Why do you fluid restrict in DKA?
Cerebral oedema
When do you start giving insulin in DKA?
1 or 2 hours after fluid replacement starts
What does do you give of insulin in DKA?
0.1 units/kg/hour CONTINUOUSLY
What do you add in after insulin starts to work
5% Dextrose (when glucose <14)
Leading cause of congenital hypothyroid in UK?
Dysgenesis/aplasia of thyroid gland
Leading cause of congenital hypothyroid worldwide?
Iodine deficiency
What medication do you give for hypothyroid (congenital) and how does dose matter?
Levothyroxine
- Start 10-15 mg/kg
- Increase by 5 very fortnight
- Maintain on 20-50 mg/kg
What would untreated congenital hypothyroidism lead to?
Cretinism
What are some symptoms you may notice if congenital hypothyroidism went undiagnosed?
Learning disability
Clumsiness
Short
Large tongue
What are some causes of critically unwell neonates?
Trauma NAI Heart disease Endocrine - CAH Metabolic - hypo's Inborn errors of metabolism Sepsis Formula issues Intestinal problems Toxins Seizures
What blood gas results might you see in congenital adrenal hyperplasia
Metabolic acidosis with partial respiratory compensation, with hyponatraemia and hyperkalaemia
If a neonate presents with CAH in <24h, how might they present?
Salt losing crisis
How would you treat a baby <24h in CAH?
NaCl, dextrose, hydrocortisone
How might a girl present with CAH?
Ambiguous genitalia
hypertrophic clitoris, fused labia
How might a boy present with CAH?
Tall stature, precocious puberty, large penis, pigmented scrotum
What is the long term treatment for CAH?
Hydrocortisone
Fludrocortisone
If you detected CAH pre-natally, how would you treat it?
Give dexamethasone to mother
How do stridor and wheeze differ?
Stridor = upper airway Wheeze = lower airway Wheeze = prolonged expiratory phase
How do you diagnose croup?
Symptoms
Symptoms specific to croup?
- Stridor
- Barking cough
- Hx coryza
- Low grade fever
What is the cause of croup?
Parainfluenza
What is first line Tx for croup?
Dexamethasone STAT
If first line Tx fails in croup and child gets more unwell, what do you do?
- Oxygen
- Nebulised adrenaline
- Neb budecanide (dex)
- IM dexamethasone
Symptoms of bronchiolitis?
- Low grade fever
- Peripheral cyanosis
- Low oxygen sats
- Increase WoB
- Widespread creps
- Bilateral wheeze
Name 4 features that might increase risk of bronchiolitis
- premature birth
- low birth weight
- congenital heart disease
- passive smoking
What would you give at risk groups of bronchiolitis?
Palivizumab immunisation
What would you detect on Guthrie’s test if a kid had CF?
Immunoreactive trypsinogen
Name 5 things that can be detected on heel prick test
- CF
- Sickle cell
- Congenital hypothyroid
- Phenylketonuria
- Maple syrup urine disorder
How might CF present in a newborn?
Meconium ileum
Prolonged jaundice
Failure to thrive
What is the genetic benefit making CF more common?
No diarrhoea
What are the symptoms on auscultation
Pansystolic murmur at lower left sternal border
Palpable thrill
What might you see on a CXR in VSD?
Enlarged pulmonary artery
Cardiomegaly
What do you treat VSD with drug wise?
Diuretics (Furosemide and Sprinolactone)
ACEi
Organic causes of faltering growth?
Inadequate intake
Malabsorption
Increased requirement
Unable to suck - cleft palate
Non-organic causes of faltering growth?
Parent education
Neglect
Child abuse
What does DMSA look for?
Renal scarring/problems
What does micturating cystourethrogram look for?
Flow
Management of constipation in kids? (4)
- Increase fluids
- Increase dietary fibre
- Movicol / lactose (osmotic)
- Stimulant (Senna)
Causes of proteinuria in kids?
- Minimal change disease
- Glomerulonephritis
- Penicillin
- Shock
- Exercise
- Infection - UTI
- Nephrotic disease
- Nephritic disease
What investigations to do if suspect nephrotic disease?
- Blood test - albumin, FBC, U&E, complement
- Urine dipstick
- USS
- Renal biopsy
What medication would you try initially for nephrotic syndrome?
Prednisolone (2mg for 4 weeks, then 1.5)
Diuretics (furosemide)
Penicillin until oedema goes
What is the moro reflex?
If baby thinks it is falling it abducts arms (spreads) and then unspreads them
What would you be concerned about if moro reflex persists?
Cerebral palsy
What is cerebral palsy?
Permanent movement disorder causing stiffness, poor coordination, visual, hearing and speech problems
What is the main cause of CP?
Hypoxia
What are the 4 types of CP?
- Spastic
- Ataxic
- Atheoid
- Mixed
Classic presentation of juvenile absence epilepsy?
Daydreaming is school repeatedly, then noticed at home. School work deteriorating
Classic presentation of juvenile myoclonic epilepsy?
In the morning, sudden jerks of muscles which cause clumsiness
Prognosis of juvenile myoclonic epilepsy?
80% stay on epilepsy meds for life
What does an APGAR score look at?
Colour Heart rate Breathing Flexion of arms and legs against resistance Grimace/reflex
Give 3 risk factors for infection in neonates
- Premature rupture of membranes
- Maternal fever
- Prematurity
What is respiratory distress syndrome?
In premature babies, there is a deficiency of surfactant which leads to widespread alveolar collapse and therefore impaired gas exchange
What would you see on a CXR if a baby had Respiratory Distress Syndrome?
Diffuse, granular ground glass appearance of lungs
Heart border indistinct
What do you need to give a baby with Respiratory Distress Syndrome?
- Surfactant
- Benzylpenicillin
- Gentamicin
Why do preterm infants get hypoglycaemia?
There is a deficiency of glycogen stores. Premature babies get hypothermic very easily, and use lots of energy to stay warm. This uses up glucose.
What complication might you get if you build up fluids too quickly?
Necrotising Entercolitis (NEC)
What symptoms would suggest NEC?
- Distended abdomen
- Aspiration of NG tube
- Increasing O2 requirement
- Blood in meconium
What would an Xray show if a baby had NEC?
- Free air in abdomen
- Necrotic bowel
- Bowel perforation
What might be a cause of shock in a premature baby?
- Intraventricular haemorrhage
- Sepsis - DIC
- NEC
- Pulmonary haemorrhage
What 4 areas might have complications due to baby being premature?
- Eyes - retinopathy of prematurity
- Hearing
- Lungs - bronchopulmonary dysplasia
- Brain - IV haemorrhages
What happens in retinopathy of prematurity?
Blood vessels in retina haven’t developed properly. This causes detachment and fibrosis.
Treatment - laser and anti-VEGF
What causes hearing problems in prem babies?
Gentamicin
What is the criteria for bronchopulmonary dysplasia?
Needing oxygen past 36 weeks of age
What are the two treatments for <24h jaundice?
- Phototherapy - converts unconjugated bilirubin to pigment that can be excreted
- Exchange transfusion via umbilical line
What is kernicterus?
When unconjugated bilirubin gets deposited in the basal ganglia and brainstem, causing encephalopathy
What are symptoms of kernicterus?
Lethargy Poor feeding Irritable Increased tone Seizures Come Death
If a baby survives kernicterus, what do they develop?
Cerebral palsy
What is the major thing you don’t want to miss in a >2 weeks jaundice baby?
Biliary atresia!!! (conjugated)
