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ISCE > Paediatric > Flashcards

Paediatric Flashcards

1
Q

what 1st investigations should you get in a child with neonatal jaundice

A
  • transcutaneous bilirubinometer
  • total serum bilirubin
  • direct coombs test
  • direct serum bilirubin
  • haematocrit
  • FBC
  • Blood packed cell volume
  • reticulocyte count
  • peripheral blood smear
  • blood group of mother and baby
  • LFTs
  • urine culture
  • abdo US
  • genetic testing
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2
Q

what questions should you ask about in a neonatal jaundice station

A

Gestational age <38 weeks
Previous sibling with neonatal jaundice requiring phototherapy
Mother’s intention to breastfeed exclusively
Visible jaundice in the first 24 hours of life

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3
Q

what investigations should you do in suspected biliary atresia?

A

Liver US
percutaneous biopsy

requires urgent Kasai procedure

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4
Q

when should you use serum bilirubin levels in neonatal jaundice?

A

in the first 24 hours of life or

who have a gestational age of less than 35 weeks.

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5
Q

What is the management of neonatal jaundice

A

Monitor transcuteanous bilirubin levels and plot on tx threshold graph
measure levels every 6 hours until bilirubin is below tx threshold and pt is stable
Monitor for signs of kernicterus - e.g. rapidly rising levels or features of acute bilirubin encephalopathy
Inform and support mum throughout - ensure breastfeeding, nappy changing and cuddles can continue + lactation support
Management = phototherapy (stop once 50 mmol below transfusino line) or exchange transfusion (counsel mum as baby needs transferred to intensive care bed

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6
Q

what does phototherapy do for baby?

A

converts the neurotoxic unconjugated bilirubin to a harmless, water-soluble isomer called lumirubin, which is readily excreted in the bile and urine

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7
Q

what should you ask in a failure to thrive station

A

ask to see growth charts and determine age of onset
- input - dietary and feeding hx
- use - energy, activity and exercise
- output - wet nappies, stool and GI sx
Others - bahviour, general health, happiness, parens health

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8
Q

what is the commonest cause of failure to thrive

A

not being offered enough food

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9
Q

what investigations would you get in suspected CF pts?

A

sweat test
immunoreactive trypsinogen (IRT test) in newborn
genetic testing

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10
Q

what is the management of cystic fibrosis

A

genetic disease with no cure, management is based on maintaining health and early tx of infections.
Resp - resp physio, positive exp pressure mask and use of abx to treat infections. NIV can be used to improve clearance techniques.
Salbutamol and mucolytics can be used.
chronic P. aeruginosa infections can be given inhaled abx. And prophylactically with azithromycin.
Early tx of infections
anti-inflammatory drugs such as alternate day steroids.
- CFTR modulators are beginning used
- lung transplant if exhausted all alternative methods
- treat pancreatic insufficiency with pancreatic enzyme replacement therapy and fat-soluble vitamin supplementation given before food + fat soluble vitamins
- monitor liver function
- risk of meconium ileus - give lactulose and surgery
- stool softeners, laxatives and hydration can be used to improve bowel habits and minimise recurrence
- tx the reflux
- monitor and optimise nutrition - high calorie diet

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11
Q

working down the body what are the characteristics of downs

A

face - dysmorphic features
neuro - developmental delay, autism and alzheimers (early onset)
heart - Arterioventricular septal defect
GI - duodenal atresia, Hirschsprungs
endocrine - Hypothyroid ,T1DM
Haem- ALL

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12
Q

what motor questions should you ask in motor for developmental delay

A

how mobile
hand dominence
balance
behavioural

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13
Q

what should you ask as part of language/social developmental delay

A

senses - hearing and vision
vocalisation/articulation
comprehension - follows commands, responds to voice
non-verbal communication - gestures, pointing
social responsiveness

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14
Q

what are key parts of the developmental hx

A 
prenatal problems - e.g. alcohol drugs 
perinatal problems - prolonged labour 
- postnatal problems? meningitis etc 
general sx - fever, lalertness 
neuro sx - fits, loc , headache, weakness or wasting.
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15
Q

what are the TORCH infections of pregnancy

A

history of toxoplasosis/rubella/CMV/herpes

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16
Q

what does the pre-natal screening test do?

A

Screening tests along with other data such as maternal age, weight, family origin and gestation are combined in software to calculate the probability of a fetus having Down’s syndrome. The screening test is considered positive if the risk of a fetus having Down’s syndrome is greater than 1 in 150. If the screening test returns a positive result, women are offered diagnostic testing

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17
Q

what is the nuchal translucency in Downs?

A

increased

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18
Q

what are the serum screen results in downs

A

Beta-hCG: raised in Down’s syndrome
PAPPA-A: decreased in Down’s syndrome

Inhibin A - raised
the rest low

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19
Q

how do you describe non-invaseice prenatal testing

A

during pregnancy the placenta sheds some cells into mothers bloodstream. This blood from mum can be sampled and predict whether or not there is a risk of a chromosomal condtion.

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20
Q

how do you confirm downs

A

Karyotype analysis of fetal cells via chorionic villus sampling (9–12 weeks gestation) or amniocentesis (15–19 weeks gestation) is the gold standard for diagnosing Down’s syndrome, with equal detection rates of around 99%. There is a higher risk of pregnancy loss with chorionic villus sampling compared to amniocentesis.19

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21
Q

what post-natal screening should be performed in downs pts

A

Echocardiography: to screen for congenital cardiovascular abnormalities
Red reflex testing: to screen for congenital cataracts
TFTs: to screen for congenital thyroid disease
FBC: to screen for myeloproliferative disorders and polycythaemia
Hearing assessment: to screen for congenital hearing issues
Radiographic swallowing assessment: performed if feeding difficulties are present to screen for gastrointestinal abnormalities (e.g. duodenal atresia)

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22
Q

what is the management of downs

A

Management of Down’s syndrome requires a tailored multidisciplinary approach to screen, diagnose and treat complications. Patients with Down’s syndrome often require ongoing regular review from relevant specialists..
Early interventional therapies - physio, OT, SALT
Educational resources -
Hearing, eye, dental and follow up thyroid checks

Genetic counselling for parents.

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23
Q

how do you describe cerebral palsy

A

non-progressive disease of the brain originating during the antenatal, neonatal, or early postnatal period when brain neuronal connections are still evolving.
80% will have a motor impairment.
Other problems = feeding difficulty, speech problems, UI

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24
Q

how do you manage cerebral palsy

A

Management is multidisciplinary and includes occupational, physical, and speech therapy; neurology and neurosurgery; psychiatry; urology; ophthalmology; and orthopaedic, paediatric, dietary, and psychosocial services. Educational and vocational support is also needed.
Tx spasticity with oral medications - baclofen
Physical, occupational, and speech therapy address motor function, communication, and activities of daily living to prevent deformity and optimise independence and quality of life. Orthopaedic interventions address contractures, scoliosis, subluxing hips, and extremity deformity.
manage epilepsy

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25
Q

what should every child with cerebral palsy get?

A

An MRI brain - may show periventricular leukomalacia

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26
Q

what is the management of paediatric GORD

A

Safety net - if vomiting becomes projectile, bile stained or bloody, poor growth or persisits beyond 1 yr and come back
- referral for breastfeeding assessment if frequent regurg with distress
reduce feed volume to trial smaller more frequent amounts
- if persists can try feed thickeners or anti-regurg formulae
- option of trialling hydrolysed protein formula to rule out cows milk protein intolerance
- education - prone and lateral positions decrease reflux but increased risk od SIDs
- PPIs or H2 antagonists may be trialled
- enteral feeding if medical management unsuccessful
- Surgical management is uncommon - nissen fundoplication

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27
Q

how is CMPA allergy diagnosed

A

2-6 week dietary modification trial

skin prick testing can be used

28
Q

why should soya protein based formulae not be used in kids with CMPA

A

10% will be sensitive to soya but can be used in lactose intolerance but not under 6months

29
Q

what is the difference between 1 and 2 lactose intolerance

A

Lactose intolerance can be primary, requiring lifelong dietary modification. Secondary lactose intolerance is usually transient following a viral infection of the GI tract, and the short-term use of a low lactose or lactose-free formula for 6-8 weeks can help to relieve symptoms.

30
Q

what is the difference between the 2 types of CMPA

A

his may be IgE mediated, in which case there is a rapid reaction to cow’s milk, occurring within 2 hours of ingestion. It can also be non-IgE medicated, with reactions occurring slowly over several days.

31
Q

how is CMPA different to lactose intolerance and CMPintoleracne

A

lactose intolerance and cow’s milk intolerance. People with cow’s milk protein allergy do not have an allergy to lactose. Lactose is a sugar, not a protein. Cow’s milk intolerance is not an allergic process and does not involve the immune system. Therefore will not have allergic sc such as rash, angio-oedeam, coughing and sneezing

32
Q

what is the management of CMPA?

A

Breast feeding mothers should avoid dairy products
Replace formula with special hydrolysed formulas designed for cow’s milk allergy
most will outgrowthe allergy by age 3
every 6 months or so trial children on first steps pf the milk ladder - e.g. malted milk biscuits and slowly progress until sx resolve

33
Q

what paed temperatures require admission to hospital

A

infants younger than 3 months with a temperature above 38ºC or 3 – 6 months with a temperature higher than 39ºC.

34
Q

what is the tx of ottitis media in children

A

Always safety-net, offering education and advice to patients and parents on when to seek further medical attention.
Simple analgesia for pain and fever
Most will resolve in 3 days and may not require Abx
Consider prescribing antibiotics at the initial presentation in patients who have significant co-morbidities, are systemically unwell or are immunocompromised. Children less than 2 years with bilateral otitis media and children with otorrhoea (discharge) are more likely to benefit from antibiotics.
can consider delayed prescription to collect after 3 days if sx havent improved
1st line = amoxicillin = erythromycin.

35
Q

how do you describe eczema to a patient

A

Eczema is a chronic, relapsing disease, and educating patients and their families is necessary so that they develop an understanding of basic skin care and how to avoid trigger factors.

36
Q

what is the management of eczema

A

Step wise approach
education e.g. avoid activities that break down skin barrier - bathing in hot water, scratching, scrubbing

Emollients (Diprobase) , topical corticosteroids (lowest potency), calcineurin inhibitors (e.g. tacrolimus)

Treat any bacterial infections.

Flares can be treated with thicker emollients = wet wraps

Coal tar, UV light therapy and systemic immunosuppresants can be used (e.g. ciclosporin)

37
Q

how do emollients work in eczema

A

By decreasing the dryness and improving the barrier function of the skin, emollients can improve symptoms of itch and pain, in addition to decreasing exposure to bacteria and sensitising antigens. Applying emollients after bathing may help to retain the moisture in the skin.

38
Q

What investigations should you get in coeliac disease?

A
  • FBC and blood smear
  • IgA-tTG and IgA levels
  • endomysial antibody
  • BMJ also advises to biopsy and skin lesions suggestive of dermatitis herpetiformis
  • small bowel endoscopy and histology
39
Q

what will endoscopy show in coeliac

A

atrophy and scalloping of mucosal folds

40
Q

what is the management of coeliac disease

A

patient education - risk stratification

  • strict gluten free diet
  • vitamin and mineral supplementation - iron, VitD, vit B12 and folate, calcium
  • assess bone mineral density after 1 year to assess for osteoporosis
  • if no response to gluten free diet refer to gastroenterologist
41
Q

how do you manage exercise induced bronchoconstriction

A

SABA 15 mons before exercise
Increase asthma medication with preventer
Non-pharm methods - training, sufficient warm-up exercise, and, if exercising in cold weather, breathing through a face mask or scarf to pre-warm and humidify air, and dietary modification
Check inhaler technique and adherence

42
Q

what is the common presentation of febrile seizures

A

A typical presentation is a child around 18 (always under 5 yrs) months of age presenting with a 2 – 5 minute tonic clonic seizure during a high fever. The fever is usually caused by an underlying viral illness or bacterial infection such as tonsillitis. Once a diagnosis of a febrile convulsion has been made, look for the underlying source of infection.

43
Q

what is the management of febrile seizure

A
  • identify cause
  • antipyretic agent

If complex febrile seizures

  • ibruprofen until fever sedates
  • diazepam may be given if repeated seizures occur

Low threshold for paed referral

Long-term management requires thorough assessment and risk stratification to devise a customised plan for each child, paying attention to the carer situation at home and day care

Systematic reviews show no benefit of antiepileptic or antipyretic tx

44
Q

how do you diagnose febrile seizures

A

diagnosis is clinical may wnat to identify source of fever

could consider

  • LP - rule out meningitis
  • blood culture
  • eeg
  • brain MRI
  • viral studies
45
Q

how do you manage bronchiolitis

A

correct abnormalities in oxygen and hydration - treatment is primarily supportive
Hospital admission if hypoxeamia, tachypneoa that is so severe it restricts oral feeding or hyrdation
if risk of aspiration = IV or NG tube
mechanical ventilation may be required
IV fluids in caution
if prior hx of wheeze give oral corticosteorids

Palivizumab for those at high risk in RSV season

46
Q

what do 25% of under 6 yr olds have if they have a UTI?

A

vesicoureteral reflex

47
Q

how do yo investigate recurrent UTIs?

A

US - all children under 6 months if 1 UTI, or children with recurrent or atypical UTIs.

DMSA - 4-6 months after illness to assess damage if recurretn or atypical UTI

Micturating cystourethrogram - MCUG to diagnose Vesico-ureteric reflux

48
Q

what is the management of uncomplicated UTI?

A

if less than 6 weeks admit and rule out sepsis/meningitis evaluation - give IV ampicillin and gentamycin unless meningitis is suspected

generally over age of 6 weeks use 3rd generation cephalosporin

tx course is usually 7-10 days in neonates,infants and children and 3 days in adolescents

49
Q

what is recurrent UTI defined as?

A

Two or more episodes of acute pyelonephritis, or
One episode of acute pyelonephritis plus at least one episode of cystitis, or
Three or more episodes of cystitis

50
Q

what are the differentials for enuresis?

A

diabetes, medications, emotional problems, urinary tract infection, spina bifida, seizure disorder, and neurogenic bladder.

51
Q

what is the management if enuresis?

A

Education - star chart
Behavioural and lifestyle - limit fluid in the evening and caffienated drinks + regular voiding habits in the day
Active tx is only offered to children over the age of 7 yrs
15% will spontanously cure wihtin the yr
bladder training therapy via a trained urotherapist

Enuresis alarm
Desmopressin can be tried.

52
Q

what are the risks with constipation?

A

faecal impaction, faecal and urinary incontinence, UTI and occassionaly abdo pain

53
Q

what is the management of constipation

A

softening stool with laxatives and faecal softeners
improving water, food and fibre intake
address anxiety in both parent and child - parents forcing children may be ineffective as voiding is painful for the child
regular toilet habits and behvioural modification are important aspects of treatment - e.g. unhurried time of the toilet

If impaction and persistent constipation surgery may be required e..g endoscopic

54
Q

what causes croup

A

parainfluenza 2,3

55
Q

what is the characteristic feature of croup

A

barking seal like cough

56
Q

what is the management of croup

A

Dexamethasone - 0.15-0.6 mg/kg as a single dose. Avoid agitation, parental assurance and eduactin to the self limiting nature of the illness.
In moderate cases nebulised adrenaline is used
in severe cases supplementary oxygen and intubation may be used

mild to moderate cases can be discharged home after 2-4 hours of obs
if significant respiratory distress pts require continous observations

57
Q

what causes whooping cough?

A

pertussis

58
Q

what are the investigations in whooping cough

A

FBC - if WBC raised suggests severe cases
PCR of nasopharyngeal aspirate
culture from nose swab

59
Q

what is the management of whooping cough

A

azithromycin or clarithromycin
advised to complete full course of abx
counsel of risks of side effects - cough may persist for several months pneumonia and bronchiectasis and safety net
Notifiable disease
supportive care
prophylactic abx in close contacts if vulnearable groups

60
Q

what is chicken pox cuased by?

A

varicella zoster = highly contagious

61
Q

what is the management of chicken pox

A

Chickenpox is usually a mild self limiting condition that does not require treatment in otherwise healthy children.

Aciclovir may be considered in immunocompromised patients, adults and adolescents over 14 years presenting within 24 hours, neonates or those at risk of complications.

Complications such as encephalitis require admission for inpatient management.

Symptoms of itching can be treated with calamine lotion and chlorphenamine (antihistamine).

Patients should be kept off school and avoid pregnant women and immunocompromised patients until all the lesions are dry and crusted over. This is usually around 5 days after the rash appears.

62
Q

what is meckels diverticulum

A

most common congenital abnormality of small bowel. May be asymptomatic for life or present before age of 2. Failure of vitelline duct to obliterate

63
Q

what are the sx of meckels diverticulum

A

age <2yrs
passage of bright red blood per rectum
intractable constipation

64
Q

what are the ix for meckels diverticulum

A

Meckels scan
FBC
plain abdo xray, US

65
Q

what is the management of meckels diverticulum

A

asymptomatic dont tx unless found during a non-acute operation

If symptomatic = resection as progression of diverticulitis can = perforation or peritonitis

66
Q

what are the developmental red flags

A 
doesnt smile at 10 weeks 
cannot sit unsupported at 12 months 
cannot walk at 18 months 
new onset gait abnormality 
any sign of developmental regression 
hand preference before 12 m - may suggest cerebral plalsy
persistence of primative reflexes >12 m

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