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YEAR 5 SPECIALTIES KEY INFO > INTRO TO PAEDS: Resp, Shock, Seizures, Rashes, DKA, UTI, Surgical abdomen > Flashcards

INTRO TO PAEDS: Resp, Shock, Seizures, Rashes, DKA, UTI, Surgical abdomen Flashcards

1
Q

What are causes of wheeze + their features?

A

Asthma = signs of resp distress, personal/family hx of atopy, >5yo

Bronchiolitis = coryzal sx, <5yo, cold months

Anaphylaxis = sudden onset, known trigger, skin: urticaria, ABCD compromise, any age

Pneumonia = fever, productive cough, any age

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2
Q

What are features of moderate asthma exacerbation?

A

PEFR >50-75%
Normal speech
No severe or life threatening features

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3
Q

What are features of severe asthma exacerbation?

A

PEFR >33-50%
RR and HR:
- >12yo = RR >25/min, HR >110bpm
- 5-12yo = >30/min, HR >125
- 2-5yo = >40/min, HR >140
Inability to complete sentences/feed
Accessory muscle use
SpO2 >92%

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4
Q

What are features of life-threatening asthma exacerbation?

A

PEFR <33%
SpO2 <92%
Reduced consciousness/GCS
Exhaustion
Heart arrhythmias
Hypotension
Cyanosis
Reduced respiratory effort
Silent chest
Normalising PCO2

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5
Q

How is a moderate asthma exacerbation treated?

A

Salbutamol MDI + spacer burst therapy (1 puff every 30-60s, max 10 puffs)

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6
Q

How is a severe asthma exacerbation treated?

A

Bronchodilators: oxygen driven, nebulised salbutamol (>5yo = 5mg, 2-5yo = 2.5mg), continuous over 30-60mins
intermittent every 20-30 min
Nebulised ipratropium bromide (>12yo = 500mcg, 2-12yo = 250mcg)

Steroids: quadruple ICS or PO prednisolone 5d (>5yo = 30-40mg, 2-5yo = 20mg, <2yo = 10mg) or IV hydrocortisone (>5yo = 100mg, 2-5yo = 50mg)

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7
Q

How is life-threatening asthma treated?

A
  1. Nebulised salbutamol + ipratropium bromide
  2. IV hydrocortisone
  3. IV magnesium sulphate
  4. IV aminophylline
  5. IV salbutamol
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8
Q

What is the chronic management of asthma?

A
  1. SABA
  2. SABA + low dose ICS
  3. Regular preventer (very low dose ICS or LRTA <5yo)
  4. Add LRTA or inhaled LABA
  5. increase ICS dose
  6. specialist care
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9
Q

How is anaphylaxis treated?

A
  1. CALL FOR HELP - lie patient flat + raise legs, stop causative agent
  2. establish airway, high flow oxygen, IV access + bolus
  3. IM adrenaline 1:1000, 0.5mg
  4. IV adrenaline if 3 failed IM (ITU admission)

Monitor for at least 6 hours (risk of 2nd wave)

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10
Q

What are causes of stridor and features of these?

A

Inhaled foreign object = sudden onset, previously well, unsupervised child, SOB/choking (any age, toddlers esp.) Mx is anaesthetists

Epiglottitis = septic looking, drooling, tripod pose, high fever, sore throat, dysphagia

Anaphylaxis = sudden onset, known trigger, skin (urticaria, angioedema), ABCD compromise

Croup = low grade fever, coryzal sx, seal-like cough, worse at night, hoarse voice. 6mo-6yo

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11
Q

How is epiglottitis managed?

A

EMERGENCY A-E
1. Secure airway
2. IV ABx = cefotaxime/ceftriaxone
3. Consider corticosteroids

NOTE: avoid looking into throat as high risk of laryngospasm

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12
Q

How is croup managed?

A

IX = Westley croup score, but mainly base mx off clinical signs and sx

MILD = no stridor at rest, single dose PO dexamethasone

MODERATE = stridor at rest, no agitation/lethargy, single dose PO/IM dex or nebulised budesonide, nebulised epinephrine

SEVERE = stridor at rest agitation/lethargy, single dose PO/IM dex or nebulised budesonide, nebulised epinephrine

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13
Q

What are early signs of shock in a child?

A

tachypnoea, tachycardia, decreased skin turgor, sunken eyes and fontanelle, delayed CRT, mottled pale or cold skin, core-peripheral temp gap, decreased UO

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14
Q

What are late signs of shock in a child?

A

Kussmaul breathing, bradycardia, confusion/depressed cerebral state, blue peripheries, absent UO, hypotension

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15
Q

What categories make up the traffic light system and what are red flag features?

A

COLOUR
- pale/mottled/ashen/blue

ACTIVITY
- unresponsive to social cues
- appears ill to HCP
- unable to be roused or stay awake
- weak, high-pitched or continuous cry

RESP
- grunting
- tachypnoea - RR >60
- moderate or severe chest indrawing

HYDRATION
- reduced skin turgor

OTHER
- age 0-3mths + temp >38
- age 3-6mth + temp >39
- non-blanching rash
- bulging fontanelle
- neck stiffness
- status epilepticus
- focal neurological signs
- focal seizures
- bile-stained vomiting

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16
Q

What are the different tpyes of shock?

A

Hypovolaemic = excess fluid loss (haemorrhagic or non-haemorrhagic)

Cardiogenic = impaired cardiac function (cardiomyopathies, arrthymias)

Obstructive = obstruction to circulation (tamponade, tension pneumo, emboli)

Distribution = loss of vascular tone (anaphylaxis, septic, neurogenic)

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17
Q

How is sepsis managed?

A

A-E approach
A = assess airway
B = 15L facemask high flow O2
C = IV/IO abx + fluid resus
- 2 large bore cannulae: 20ml/kg 0.9% saline over 5-10mins
- administer 2nd bolus if still signs of shock
- up to 60ml before considering rx w/vasoactives
- IO access if IV access unattainable (below tibial tuberosity medially)
- take blood gas, lactate, glucose, cultures
- abx = if <3mths cefotaxime + amipicillin, if >3mths ceftriaxone

Consult senior clinicians
Consider inotropic support early (epinephrine, norepinephrine)

If ? or confirmed bacterial meningitis also give 0.15mg/kg dexamethasone

Add IV acyclovir to cover HSV encephalitis

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18
Q

How is status epilepticus managed?

A

DEFINITION = seizure lasting >5mins

  1. airway, high flow oxygen, check glucose, protect from injury by cushioning head, removing objects, no restraint
  2. AT 5 MINS:
    - vascular access available = IV/IO lorazepam
    - no vascular access = buccal midazolam (or rectal diazepam)
  3. AT 15 MINS:
    - IV/IO lorazepam
    - call for senior help
  4. Phenytoin (reconfirm it’s an epileptic seizure), consider paraldehyde PR whilst preparing or infusing phenytoin
  5. AT 25 MINS:
    - senior help needed
    - seek anaesthetic/ICU advice
    - phenytoin IV over 20mins OR if already on it then phenobarbitone IV/IO over 5mins
  6. AT 45 MINS:
    - rapid sequence induction of anaesthesia w/thiopental (thiopentone)
    - anaesthetist must be present
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19
Q

What are causes of seizures?

A

METABOLIC = electrolyte abnormalities, hypoglycaemia, hyperglycaemia, inborn errors of metabolism, toxins/poisons

INFECTIVE = meningitis, encephalitis, febrile seizure, sepsis

STRUCTURAL = epilepsy, head trauma/injury, non-epileptic seizures, SOL

CONGENITAL = infantile spasm/West syndrome

OTHER = breath holding attacks, reflex anoxic seizures

20
Q

How are seizures/unwell child investigated?

A

BEDSIDE: urinalysis, LP (sent for gram stain + MC&S, PCR, biochemistry)
BLOODS: FBC, U&Es, LFTs, blood glucose, ketones, lactate, toxicology, blood cultures, ABG
IMAGING: CT head, MRI brain

21
Q

What are sx of raised ICP?

A

altered LOC, irritability, restlessness, drowsiness, papilloedema, focal neuro signs, prolonged seizures, constant headache (worse on lying down), sudden vomiting w/o nausea, fixed dilated pupils, asymmetrical

CUSHING’S TRIAD = bradycardia, irregular respirations, hypertension

22
Q

What are contraindications to lumbar puncture?

A
  • clinical or radiological signs of raised ICP
  • shock
  • after convulsions until stabilised
  • coagulation abnormalities
  • local superficial infection
  • respiratory insufficiency

perform delayed LP in children w/?bacterial meningitis when CIs no longer present

23
Q

How to identify type of meningitis from LP?

A

Bacterial = turbid, high polymorphs, high protein, low glucose

Viral = clear, high lymphocytes, normal or high protein, normal or low glucose

TB = turbid/clear/viscous, high lymphocytes, very high protein, very low glucose

24
Q

What are causes of early onset meningitis?

A

<72hrs postnatally = GBS, E. Coli (gram -ve rod), Listeria monocytogenes (gram +ve rod)

25
Q

What are causes of late onset meningitis?

A

> 72hrs, within 28d postnatally = strep. pneumo (gram +ve coccus), N. meningitides (gram -ve coccus), Staph aureus (gram +ve diplococci clusters).

26
Q

How should meningoencephalitis be followed up?

A
  • formal audiological assessment: ideally before discharge & <4w of being fit to test (severe profound deafness = urgent assessment for cochlear implants as soon as fit to test)
  • paediatrician r/v 4-6w after discharge (consider specific morbidities e.g. hearing loss, orthopaedic, skin, psychosocial, neurological and developmental, renal failure)
  • inform GP/health visitor, school nurse: long term sequelae
27
Q

What are the differences between a simple febrile convulsion and complex FC?

A

SIMPLE = <15mins, generalised tonic-clonic, no recurrence within 24hrs, no postictal pathology or residual weakness

COMPLEX = >15mins, focal convulsion w/ or w/o secondary generalisation, recurrence within 24hrs even if shorter subsequent seizures, Todd’s paresis may be present (period of paresis of affected limb)

28
Q

When should a child with febrile seizures be admitted?

A
  • complex febrile seizures
  • first febrile seizure
  • reduced GCS before seizure
  • slow recovery >1hr
  • clinical signs of meningism
  • focal neurological deficit
  • features of septicaemia
  • unexplained cause of fever
29
Q

How does NAI present and how is it investigated and managed?

A

SX = bruises, burns, fractures, shaken baby syndrome

IX =
- Bedside: full exam, body mapping
- Bloods: FBC, clotting
- Imaging: skeletal survey (repeat at 2w), CT head (if acute), MRI (if non acute), ophthalmology r/v

MX =
- admit + senior review
- contact hospital safeguarding team (may contact social services and/or police)
- child may go home while investigation underway

30
Q

What is the difference between measles, rubella and roseola infantum?

A

MEASLES = conjunctivitis, cough, coryza, fever, Koplik spots on buccal mucosa, rash starting at hairline and spreading downwards over 3d

RUBELLA = headache, low grade fever, sore throat, coryza, forchheimer spots on soft palate

ROSEOLA INFANTUM = exanthem subitum = 6-36mths, caused by HHV6, abrupt high fever, rash starting on neck and trunk and then spreading to face and extremities after fever is gone

31
Q

What is the routine immunisation schedule?

A

8w =
- diptheria/tetanus/pertussis/polio/Hib/HepB
- MenB
- rotavirus

12w =
- diptheria/tetanus/pertussis/polio/Hib/HepB
- pneumococcal
- rotavirus

16w =
- diptheria/tetanus/pertussis/polio/Hib/HepB
- MenB

1yr old =
- HiB and MenC
- pneumococcal
- MMR
- MenB

32
Q

What are the diagnostic criteria for Kawasaki’s disease?

A

Prolonged fever >5d

+4/5 other sx (CRASH)
- conjunctivitis
- rash (hands and feet)
- adenopathy (cervical)
- strawberry tongue
- hands and feet swelling/peeling

33
Q

How is Kawasaki’s disease managed?

A

ADMIT
IV IG within 10d + high dose aspirin +/- corticosteroids (alt = infliximab, cyclosporin)

Arrange echo (risk of coronary aneurysm - need for long term warfarin)

34
Q

Summarise scarlet fever?

A

Strep A

Sx = sandpaper rash, strawberry tongue, sore throat, rheumatic fever

Ix = throat culture, rapid antigen test

Mx = phenoxymethylpenicillin

35
Q

Summarise erythema infectiosum?

A

parvovirus b19

sx = slapped cheeks, coryza

mx = supportive

36
Q

Summarise hand, foot and mouth disease?

A

Coxsackie virus A16

sx = small blisters hand and feet and around mouth

mx = supportive

37
Q

Outline how to investigate abdominal pain?

A

BEDSIDE = abdo + external genitalia exam, obs, urinalysis, pregnancy test (if relevant)

BLOODS = FBC, U&Es, LFTs, clotting, G&S, XM, amylase, glucose, ketones, lactate, blood cultures

IMAGING = non-contrast CT abdo, abdo USS, AXR, erect CXR

38
Q

What are causes of a wide anion gap?

A

WIDE = >30mmol/L
LTKR: Lactate, Toxins, Ketones, Renal

39
Q

What are causes of a normal anion gap?

A

NORMAL = 4-12mmol/L
ABCD: Addisons, Bicarb loss (GI or renal loss), Chloride excess, Diuretics (acetozalamide)

40
Q

What is the diagnostic criteria for DKA?

A

Hyperglycaemia (BM>11.1)+ metabolic acidosis (pH<7.3/bicarb <15) + ketonaemia (>3)

Severity​:
MILD: pH 7.2-7.29, bicarb <15
= 5% dehydration​

MOD: pH 7.1-7.19, bicarb <10
= 7% dehydration​

SEVERE: pH <7.1, bicarb <5
= 10% dehydration​

41
Q

How is DKA managed?

A

1 = FLUIDS
- Bolus volume - if in shock 20ml/kg over 15min, if not shocked then 10ml/kg
- Deficit volume - deficit % x 10 x body weight mL/h - added to maintenance over 48h
- Maintenance volume - over 48h, 0.9% NaCl 100/kg for first 10kg, 50/kg for 10-20kg, then 20/kg above 20kg, +40mmol KCl per 1L fluid once UO

2 = INSULIN
- 1-2hrs after fluid therapy
- IV actrapid 0.05-0.1 units/kg/hr
- target rates: BM decreased >3/hr, ketones decreased >0.6 or bicarb increased >0.3
- continue long-acting SC insulin at usual dose and time
- once BM <14 add dextrose (5% if BM 8-14; 10% if BM <8)
- 2mL/kg bolus 10% dextrose if BM < 4 (hypoglycaemia)

3 = MONITORING
- every 1hr = neuro obs, capillary glucose
- every 2-4hr = electrolytes, blood gases, ketones

42
Q

How is a UTI diagnosed in children and how is it managed?

A

UTI = pure growth of single organism >10^5 CFU/L

Rx = 3/7 trimethoprim PO
- IV abx if <3mo
- 7-10d course if upper UTI

43
Q

How are UTIs investigated according if under 6 months?

A

Single confirmed UTI, responds rapidly to treatment

IX = USS urinary tract

44
Q

What is an atypical UTI and how is it investigated?

A

FEATURES = seriously ill, septicaemia, poor urine flow, abdominal or bladder mass, raised serum creatinine, failure to respond to abx within 48hrs, non E. coli organisms

IX =
- USS urinary tract during acute episode
- DMSA scan 4-6mths later if <3yo
- MCUG if age <6mo

45
Q

What is recurrent UTI and how is it investigated?

A

FEATURES = 3 or more episodes of cystitis/lower UTI OR 2 or more episodes of UTI if any episode involved upper UTI (renal angle tenderness)

IX =
- USS urinary tract
- DMSA 4-6mo later
- MCUG if <6mo

46
Q

How is surgical abdomen in children managed generically?

A
  1. NBM
  2. NGT on free drainage
  3. IV fluids
  4. IV analgesia (avoid opioids if ?obstruction)
  5. IV Abx
  6. liaise w/surgical SpR
  7. liaise w/CEPOD (dedicated theatre lists for emergencies)

YEAR 5 SPECIALTIES KEY INFO (16 decks)

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