more paeds Flashcards
how do you measure for coeliac in a child with already established IgA deficiency
IgG endomysial antibody
intussusception investigation
abdominal USS
A 3-year-old girl is brought to the clinic with a fever, runny nose, cough, and red eyes. She has developed a rash starting at the hairline and spreading downwards. There is no discharge from the eyes and the cough is non-productive.
What is the most likely diagnosis?
measles (especially if koplik spots)
An 18-year-old female presents with a 4-day history of fevers up to 40.5 °C and coryzal symptoms. She noticed her eyes were red this morning, so presented to the Urgent Care Centre.
She is an asylum seeker and has moved across multiple countries since childhood. She has moved to the UK 3 months ago and lives in a hostel. She has no significant past medical history. She takes no regular medications.
On examination, heart rate (HR) is 130 bpm, respiratory rate (RR) 50 breaths/min, temperature 40.2 °C, blood pressure (BP) 135/80 mmHg. Ears, nose and throat (ENT) examination revealed normal-sized tonsils.
What is the most likely diagnosis?
Measles classically presents with fevers above 40 °C and coryzal symptoms. Conjunctivitis usually develops 2–5 days after onset of symptoms, followed shortly by a maculopapular blanching rash typically starting on the face/behind the ears, migrating to the neck, trunk and legs. Koplik spots in the oral mucosa are also pathognomonic for measles.
This patient has had a disturbed childhood due to her asylum-seeker status, having moved across multiple countries. It is likely that she did not receive childhood immunisations, and this makes her more susceptible to measles in adulthood.
A 2-hour old baby boy vomits green fluid immediately after his first feed. The baby was born by a spontaneous vaginal delivery at 37 weeks after a pregnancy complicated by polyhydramnios. The baby’s APGAR scores at 1, 5 and 10 minutes were 8, 9 and 10 respectively.
On inspection, the neonate has a a wide gap between the big toe and second toes bilaterally. An abdominal x-ray is performed which shows a distended stomach and distended duodenum, which are separated by the pyloric valve.
Which of the following genetic changes is most likely present in this baby?
downs- duodenal atresia
A full-term newborn is delivered via emergency cesarean section due to prolonged foetal bradycardia. At one minute of life, the baby is limp, cyanotic at the peripheries, and apnoeic. The heart rate is 50 beats per minute. The APGAR score is 2 (1 for heart rate, 1 for colour).
What is the most appropriate next step in the management of this newborn?
start positive pressure ventilation
A 31-year-old nulliparous woman at 38 weeks gestation was being induced in the maternity ward. After a review by the midwife, she is rushed into theatres for an emergency c-section after there was evidence of foetal distress.
On delivery of the baby, the baby looks floppy and pale, does not cry and has a heart rate of 58 beats per minute.
What is the first step in managing this neonate?
Clamp the cord
Given the assessment of the baby featuring poor cardiac and respiratory effort, the cord should immediately be clamped, and the baby should be transferred to the resuscitation platform for resuscitation to take place. In neonates who require resuscitation, the Resuscitation Council UK advise delaying cord clamping if possible, however, if necessary, neonates could have their cord clamped sooner to prevent delays in resuscitation.
measles school exclusion
4 days from onset of rash
describe nappy rash with infantile seborrheic dermatitis
Widespread, erythematous lesions over the buttocks and perineum with a fine overlying scale. The rash is non-itchy and involves the skin folds.
paeds GCS score
A 4 year old boy is brought to A&E after his parents heard him have a ‘fit’. The parents checked on him at 4am because he was making noise in his sleep.
They found him with his back arched and teeth clenched, purple in the face and salivating. This lasted for about 5 minutes, after which he was confused for about 10 minutes and is still sleepy. He had no fever and was completely well the day before, with no headache or neck stiffness. This has never happened before during the day or night. On questioning, the parents say they have twice found him in the morning sleeping on the floor next to his bed, and sometimes he gets in a tangle with his duvet overnight. He is otherwise healthy and takes no medicines. No one else in the family has fits.
On examination at 5am, the child appears slightly sleepy but well. His chest is clear and heart sounds I + II are present, capillary refill is <2 seconds peripherally and temperature is 36.8 degrees. There is no evidence of focal neurological signs. An outpatient overnight EEG shows characteristic central-temporal spikes.
What is the most likely prognosis of this condition?
Child will outgrow fits around puberty
This 4 year old child who has had a witnessed seizure at night, and evidence of potential previous seizures at night (asleep on floor, messy bed) with centro-temporal spikes on EEG is most likely to have a diagnosis of benign rolandic epilepsy. Benign rolandic epilepsy has an excellent outcome and the vast majority of children outgrow the condition and stop having seizures around puberty
2 doses of buccal medazolam failed to stop seizure what should be given
IV leviteracetam
treatment for intussusceptions without peritonism
Air enema
The diagnosis is intussusception. For patients without peritonism, this is the first line treatment, and is successful in 75%. Air is used to create pressure within the intestine to resolve the obstruction
suspected urosepsis treatment
Tazocin is a broad-spectrum antibiotic that can treat urinary tract infections.
What is the correct technique for chest compressions in Paediatric Basic Life Support?
Lower half of the sternum, 100 compressions per minute
