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Paediatrics > Pad notes for First Two Rotations > Flashcards

Pad notes for First Two Rotations Flashcards

1
Q

How long do you have to wait after C-section before you can get pregnant again and why?

A

1 year because you have to wait for the womb to heal

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2
Q

How to manage a C-section scar

A

Massage it after shower to avoid fibrosis of the scar and it being pulled inwards - to get a thin and white scar

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3
Q

Insertion of IUD after birth

A

Can’t insert IUD before 3 months after birth because womb is not back to its normal size and it will be expulsed

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4
Q

Risk factors for late miscarriage x3

A

Scars on uterus
Previous late miscarriages
Fibroma or mass in uterus

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5
Q

Where is affected with hydra-adenitis?

A

Groin, armpits, between buttocks, labia, below breasts, on buttocks

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6
Q

What happens with hydra-adenitis?

A

Abscesses, swelling, pain and boils

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7
Q

Treatment of hydra-adenitis?

A

Infliximab treatment, 4-weekly infusions

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8
Q

What vitamin are all babies given and why?

A

All babies are given vitamin K because they don’t have vitamin K stores
Therefore give any child with prolonged clotting extra vitamin K, check 6 hours later and liver should have had time to synthesise vitamin K

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9
Q

What sort of milk do children with chronic liver disease get?

A

Milk with MCT’s (medium chain triglycerides) in it because they are water soluble therefore more easily absorbable

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10
Q

What is galactosemia?

A

Rare genetic disorder that affects an individuals ability to metabolise galactose leading to toxic levels of galactose-1-phosphate

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11
Q

Symptoms of galactosemia?

A

Galactosemia leads to hepatomegaly, cirrhosis, renal failure, cataracts, vomiting, seizure, hypoglycaemia, lethargy, brain damage and ovarian failure

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12
Q

Management of galactosemia

A

Stop breast milk to cure

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13
Q

Why is EBV bad in immunosuppressed patients and what happens pathologically?

A

Because T cells are low when immunosuppressed therefore get EBV B cells and these colonially expand because there are no T cells stopping them - therefore get lymphadenopathy from B cell proliferation

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14
Q

What is Sandifer syndrome?

A

Syndrome of gastro-oesophageal reflux and neurological symptoms

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15
Q

Symptoms of Sandifer syndrome?

A

Spasmodic torticolis and dystonia and gastro symptoms

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16
Q

Treatment of Sandifer syndrome

A

Treatment of associated underlying disease eg. GORD or hiatus hernia

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17
Q

What do you worry about with seizures in a child

A

Neurological problem - eg. neuro migrational disorder etc. always do MRI
Infection - eg.meningitis
Cardiac - look for cardiac SVT - floppy, sweaty and pale
Metabolic - check glucose, lactate, ammonia, amino acids, u&e’s, cardinitine

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18
Q

What do you query if child is not moving arm in first few months

A

Surgical trauma eg. clavicle fracture most common

Or NAI

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19
Q

When are febrile convulsions seen?

A

5/6 months to 5/6 years

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20
Q

Characteristics for febrile convulsions x5

A

Temperature just needs to be high
Need to normalise after seizure
Duration 1 then complex febrile seizures)

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21
Q

Risk of having a second febrile seizure if you have a first

A

30% risk of another seizure

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22
Q

How do you do neonatal MRI

A

Feed and wrap or General Anaesthesia

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23
Q

What do you give for status epilepticus in children

A

Diazepam is not given

Lorazepam if access or rectal

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24
Q

Another name for metopic synostosis and what is it?

A

Trigonocephaly - premature fusing of the metopic suture causing a triangular shape to the forehead

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25
Q

What does valproate to do lamotrigine?

A

Valproate increases lamotrigine half-life

All enzyme inducers do this to lamotrigine

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26
Q

What effect can topiramate have on kidney

A

(Treatment for tonic clonic)

It can cause renal stones

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27
Q

What type of pain do you get with Gall Stones?

A

Colicky (coming and going) RUQ pain and jaundice

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28
Q

What is Gilberts syndrome

A

GAL 1 enzyme dysfunction - high bilirubin in blood - can cause jaundice

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29
Q

What is given after splenectomy

A

Lifelong penicillin because risk of being immunocompromised and risk of pneumococcus infection

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30
Q

Type of wheeze in foreign body obstruction

A

Unilateral, sudden onset and also red in the face

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31
Q

What would you see in xray of foreign body

A

Normally in right bronchus and would see hyperinflation distal to obstruction due to air trapping

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32
Q

What would you hear on auscultation in bronchiolitis

A

More creps and crackles than a wheeze

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33
Q

What is burst therapy?

A

Back to back salbutamol nebulisers to open up the airway

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34
Q

What treatment differs between asthma-induced and virus-induced wheeze?

A

Won’t give steroids in virus induced wheeze because they are immunosuppressants

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35
Q

When do you get productive cough in children?

A

After age 5/6 - can’t really cough up sputum before this

Therefore for sputum sample will need to do gastric washout

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36
Q

What is NPA

A

Nasopharyngeal aspirate - send to lab to see if growing any viruses

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37
Q

Maternofetal risk factors for infection in neonate

A 
Vaginal swab +ve for streptococcus
Maternal fever during pregnancy 
Rupture of sac >12 hrs 
Meconium in amniotic fluid 
Neonatal fever 
Antibiotics to mum during birth
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38
Q

What is Mesenteric Adenitis?

A

Swollen lymph glands in the abdomen - causes abdominal pain similar to appendicitis therefore diagnosis of exclusion when appendicitis can be excluded
Usually clears up without treatment

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39
Q

Lung infection in child with CRP 160 will pretty much always be …

A

…pneumococcus

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40
Q

DDX for difficulty breathing and fever in

A

Ear infection

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41
Q

Green vomit

A

Obstruction

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42
Q

Presentation of volvulus

A

Acute and grave presentation with vomiting and occlusive signs

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43
Q

Choking patient develops unilateral wheeze - what should you do

A

Not do Haemlick because obstruction has passed into the bronchus and can make it worse

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44
Q

What should not be given nutritionally before age 1

A

Salt

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45
Q

What do Barlow and Ortalami look for

A

Hip dislocation due to developmental dysplasia of the hip

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46
Q

What is the significance of PCT

A

Rises early when bacterial infection - doesn’t rise in viral

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47
Q

What can be confused with cardiomegaly on infant chest x-ray

A

Thymus gland

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48
Q

What does herpes eye infection give

A

Keratitis - very sore granuley/gritty infection of cornea

Very painful to move eyelid - infant will keep eye shut to avoid pain

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49
Q

What do you suspect if recurrent prolonged fever in infants - at least a week every 1/2 months

A

Ask if it is an inflammatory syndrome

50
Q

Signs of respiratory distress

A

Intercostal and subcostal pulling
Balancement thoracoabdominal
presternal pulling
Nostrils

51
Q

How will a child with spondylitis present?

A

Inflammation of joints of backbone - won’t be able to stay sitting up because will be too painful

52
Q

What do you suspect if limping and fever

A

Joint infection

53
Q

Which way should babies sleep?

A

Not on their front because they do not have the instinct to turn their head if they can’t breathe and this can lead to suffocation

54
Q

What is Marshall syndrome?

A

Genetic disorder of connective tissue that can cause hearing loss.
Areas commonly affected are eyes (uncommonly large), joints and mouth and facial structures

55
Q

When does neck stiffness become significant? (what age)

A

Before 18months-2 years - therefore before then not very useful

56
Q

How does neonatal colic present?

A

Crying, abdominal pain, bloated and gas - not really blood in stoold

57
Q

Normal neonatal stool

A

Semi-liquid with bits in it (yellow/gold) becomes more consistent as mothers milk changes

58
Q

What is Sanfillipo syndrome?

A

Inability to break down mucopolysaccardies (type of sugar)
Presents later in life, post-2, may have abnormal facies and then neurological problems and marked behavioural problems
Do not usually live past early 20s

59
Q

What is neonatal mastitis

A

Inflammation of neonatal breast tissue due to hormones from mothers milk - not a problem but can get infected -

60
Q

What happens to proteins with inflammation

A

All go up except albumin which goes down and transferrin which doesn’t change

61
Q

Presentation of bowel invagination

A

PR bleed, sudden pain, malaise, can lose consciousness

62
Q

Treatment of bowel invagination

A

Wash out up anus with sodium solution - should undo vagination. If it doesnt then surgery to undo and check for necrotic bowel

63
Q

Minimum 3 things that need assessing in mobility assessment of elderly

A

Proprioception
Hip flexion and extension
Gait

64
Q

What sort of fracture are osteoporotic fractures?

A

Low trauma fractures in bones which are normally strong eg.hip, femur, spine and humerus

65
Q

When do Bisphosphonates need to be taken and how? 2 details

A

Take first thing in the morning on empty stomach because poor bioavailability and food therefore decreases availability of medication
Also upright with large glass of water to reduce risk of oesophagitis

66
Q

Eg of Bisphosphonate

A

Alendronic acid

67
Q

What dosage can be used for Bisphosphonates?

A

Once a week large dose

68
Q

Which medication is relevant in dhx for oestoporosis?

A

Steroids

69
Q

What 3 conditions are risk factors for osteoporosis?

A

T1DM
Rheumatoid arthritis
Any malabsorption syndrome

70
Q

Social risk factor for osteoporosis x2

A

Smoking

Drinking >21 units of alcohol a week in women

71
Q

1st step of Who Pain ladder

A

1) paracetamol regular

+/- NSAIDs if no contraindication

72
Q

4 red flags for bowel Cancer

A

Change in bowel habits
Blood in stool
Tenesmus
Palpable mass

73
Q

Who is needed to intervene if patient gets pressure ulcer in hospital

A

Tissue viability nurse

74
Q

4 ways to prevent pressure ulcer in hospital

A

Rotation every 2/4 hours
Pressure relieving mattress
Prevlon boots
Check elbows, sacrum and heels at least once a week

75
Q

Blood clot prevention in hospital, and change if poor renal function

A

Enoxaparin LMWH normal

If eGFR is

76
Q

Two molecular indicators of rheumatoid arthritis

A

Anti-CCP antibody has highest specificity

Rheumatoid factor has high sensitivity but low specificity

77
Q

What does paracetamol regularly need to be based on

A

Weight - only 1g QDS if >50kg

Also check LFTs

78
Q

Contraindications for NSAIDs x3

A

Stomach problems, asthma/COPD, kidney problems

79
Q

What sort of pain are NSAIDs good for?

A

Good for bone pain

Can be given PR to reduce GIT side effects

80
Q

What is step 2 of WHO pain ladder?

A

Weak opiates (codeine, tramadol, dihydrocodeine)
+ PRN laxatives and antiemetics
Keep baseline paracetamol

81
Q

Step 3 of WHO pain ladder

A

Strong opioids (morphine sulphate, buprophine, oxycodone, fentanyl, alfentinil, diamorphine)

82
Q

Which is first choice in WHO Step 3 and when is this changed?

A

Morphine is first choice but if liver/kidney function goes then fentanyl or alfentinil

83
Q

What do you do with step 2 medication when escalating to step 3 of WHO pain ladder?

A

If just need a bit more pain relief to top up when moving - the keep step 1 and 2 and use anticipatory PRN oromorph
If pain all the time with step 2, then get rid of weak opiate and use strong opiate

84
Q

How do you decide dose for strong opiate in WHO step 3?

A

Do PRN oromorph, see how much they need. Then add it up and the next day give half in the am and half in the pm and PRN if they need extra

85
Q

What can be added to who pain ladder if neuropathic pain

A

All away along can give neuropathic pain adjuvants - gabapentin, pregabalin, amitriptyline, carbamazepine

86
Q

Non-pharmacological management of pain x4

A

TENS machine, hot water bottle, hydrotherapy, CBT

87
Q

Non pharmacological management of nausea and vomiting x2

A

Ginger

Peppermint water

88
Q

Non pharmacological management of breathlessness x5

A

Chest physio, handheld fan, relaxation, singing, CBT

89
Q

Pharmacological management of breathlessness

A

Weak opiates

90
Q

Which is the best laxative for Opiate constipation?

A

Senna

91
Q

Which antiemetic is not good to give with bowel obstruction?

A

Domperidone because it is a prokinetic

92
Q

Most common cause of fine crackles on auscultation

A 
Pulmonary fibrosis (IPF, drugs, rheumatoid, chemo) 
Sarcoid
93
Q

Which drugs can cause pulmonary fibrosis? X4

A

Methotrexate, amiodarone, chemotherapy, nitrofurantoin

94
Q

What is nitrofurantoin

A

Antibiotic used for urinary tract infections

95
Q

Cause of coarse crackles

A

Chest infection

96
Q

What is indapamide?

A

Thiazide diuretic (causes k+ loss)

97
Q

What is ondansetron?

A

Antiemetic used to treat nausea caused by chemotherapy and surgery

98
Q

What is DOLS?

A

Deprivation of liberty safeguard - keeping against wishes but in best interest
Should be used for basically any patient with dementia who can’t leave a hospital

99
Q

What is HNA?

A

Health needs assessment

100
Q

How can fluids be given in palliative care and what sort?

A

Can be given SC rather than IV but only saline (not dextrose or Hartmann) and very slowly - 10-12hr bag

101
Q

What do you hear on cardiac auscultation with pulmonary hypertension?

A

Loud p2 over pulmonary valve area

102
Q

How are left sided murmurs best heard?

A

In expiration

103
Q

What can occur after the release of renal obstruction?

A

Post obstruction diuresis - get large electrolyte imbalance

104
Q

Indications for using NG tube x4

A

Unsafe swallow (smaller feeding tube)
Neuromuscular
Aspiration for obstruction and vomiting (Rialls tube - larger)
Giving medications which can’t be given IV eg.betablockers

105
Q

Investigations of causes of a fall x2

A

Sitting and standing BP

infection screen

106
Q

Investigations of consequences of a fall x2

A

Ct scan

X-ray for fractures

107
Q

What is needed for capacity according to the mental capacity act x4 stages

A

Need to understand a clear question
Need to understand risk and benefits
Need to be able to remember long enough to make an informed decision
They need to be able to communicate this decision to you

108
Q

What should be starting point for assessing capacity

A

Assume they have capacity unless proven otherwise

109
Q

What act comes into play if they lack capacity

A

Best interest act

110
Q

What is an Advanced Care Plan?

A

Supposed to influence best interest decisions - not legally binding and can’t get sued if you don’t use it but you should try to

111
Q

What is an advanced directive which is legally binding?

A

Advanced decision to refuse treatment - unlike the advanced care plan is is legally binding

112
Q

Sections for discharging patient as part of continuing healthcare checklist

A

Section 2 needs to be done minimum of 48hours before discharge to prepare package of care
Section 5 done minimum 24hours after section 2 and 24hrs before discharge - means patient is now fit for discharge

113
Q

Effects of long term steroids x5

A 
Bone problems - osteoporosis 
Gastritis therefore give PPI
Can cause and derange diabetes 
Weight gain 
Immunosuppression
114
Q

Side effects of quetiapine

A

Drowsiness

115
Q

Effect of dementia treatment on MMSE scores

A

Study showed that MMSE score increased when dementia patients are treated with paracetamol instead of anticholinesterase inhibitors - implying pain may have a role in dementia

116
Q

What is risk associated with c.diff infection

A

Can cause toxic mega colon which is very dangerous - therefore monitor inflammatory markets and check for bloated abdomen

117
Q

What can occur post prostate treatment

A

Stress incontinence

118
Q

What is functional incontinence

A

Because unable to reach the toilet eg. Due to immobility

119
Q

Lifestyle risk factor for gynaecomastia

A

Increased alcohol intake

120
Q

Causes of mastalgia

A

Usually no pathological cause - breast cancer is typically painless

121
Q

Scale for risk of breast cancer from examination/investigation

A 
B1 - normal 
B2 - something but benign 
B3 - something probably benign 
B4 - something probably malignant 
B5 - something and malignant

Paediatrics (16 decks)

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