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Finals > Paediatric Medicine 🧒🏻 > Flashcards

Paediatric Medicine 🧒🏻 Flashcards

1
Q

Diagnosis of T1 DM

A

Random blood glucose above 200 and symptoms. Need two readings if asymptomatic. Or fasting above 126

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2
Q

Potential antibody testing for T1 DM patients

A

Anti GAD, anti islet cell,

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3
Q

Other than insulin, what management should we give to diabetics (T1)

A

Routine screening and do Vx’s

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4
Q

First invx for DKA

A

Glucose test

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5
Q

General invx for DKA aside from glucose

A

ABG, urinalysis, workup for cause

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6
Q

Name as many reasons when you would consider an ICU transfer in DKA

A

Ketone > 6
HCO3 < 5
pH < 7
K < 3.5
GCS < 12
O2 < 92%
SBP < 90
AG > 16

(HOPAKS slava ukarini)

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7
Q

Management of DKA

A

Fluid resus (isotonic), insulin, K+ due to risk of hypokalemia when admin insulin, IV HCO3 in severe met ac.

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8
Q

Hypoglycaemia level in diabetics vs non diabetics

A

Diabetics: <70
Non diabetics: <55

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9
Q

Whipple triad for hypoglycemia

A

Low glucose, signs of low glucose, relief of symptoms when eat glucose

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10
Q

Neurogenic/autonomic hypoglycaemic symptoms

A

SNS signs, tremor, pallor, tachycardia, sweating, palpitations.
PNS signs, hunger, parenthesia, N/V

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11
Q

Neuroglycopenic hypoglycaemic symptoms

A

Agitated, confused, AMS, fatigue, seizure, somnolence (coma and death)

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12
Q

First Invx for hypoglycemia

A

Glucose test

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13
Q

Mx of hypoglycemia (if alert, if AMS)

A

If alert: oral glucose/fruit juice etc.
If AMS: IV dextrose (may need multiple doses). IM glucagon if no IV access

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14
Q

After treated hypoglycemia, how to Invx? (Diabetic vs non diabetic patient)

A

Check for acute illness, review meds if diabetic.
Labs, CXR, urinalysis, insulin, c peptide levels if no obvious cause.

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15
Q

Is pregnancy still possible in Turners

A

Yes, with IVF, using donor oocytes and exogenous estradiol/progesterone

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16
Q

3 elements to the diagnosis of Turners

A

Clinical. Low E. High FSH. Karyotype to confirm

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17
Q

Two hormone therapies for Turners, and one important surgery

A

Estrogen/progesterone Tx, GH Tx, remove streak gonads

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18
Q

EEG for absence seizures

A

3Hz spikes in all regions of the brain

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19
Q

1st line for absent seizure

A

Ethosux (2nd line: valproate )

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20
Q

3 main types of cerebral palsy (based on brain location affected)

A

Spastic (motor cortex), Dyskinetic (basal ganglia), ataxic (cerebellum)

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21
Q

Main risk factor for cerebral palsy

A

Preterm and low birth weight

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22
Q

Hand preference before age 1… is this a red flag for what?

A

Hemiplegia

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23
Q

How to diagnose cerebral palsy

A

It’s a clinical diagnosis. Consider cranial US in neonates and MRI in older infants (see haemorrhage, hypoxia, periventricular leukomalacia)

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24
Q

Cure for Cerebral Palsy?

A

No. Just improve QoL

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25
Q

Mx for cerebral palsy

A

Therapy (physical, occupational, speech, educational, nutritional, social). Antispasmodics (botulinum, baclofen, dantrolene, benzodiazepines).

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26
Q

Most common cause of intellectual disability

A

Downs

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27
Q

First trimester tests results for downs fetuses

A

Low PAPP-A, high BHCG, nuchal translucency

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28
Q

Second trimester tests results for downs fetuses

A

BHCG and Inhibin high
Estriol and AFP low

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29
Q

If screening for downs indicates increased risk, what confirmatory tests can we do?

A

9-14 wks: Chorionic villus sampling
15-22 wks: amniocentesis

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30
Q

Simple vs complex febrile seizure

A

Simple: tonic clonic, generalised, less than 15 mins, one in 24 hours

Complex: focal, one side of body, more than 15 mins, more than one seizure in 24 hours. (Complex if 1 or more met)

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31
Q

Aim of diagnostic workup in simple febrile seizure.

A

Find cause (no specific workup)

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32
Q

diagnostic workup in complex febrile seizure? and the aim?

A

EEG and imaging needed! To find underlying cause

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33
Q

When do we give abortive therapy for febrile seizure

A

If complex, or if lasts >= 5 mins. Give IV diazepam

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34
Q

Mainstay treatment for febrile seizure

A

NSAID/paracetamol to reduce fever

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35
Q

Causes of meningitis if less than 1mo

A

Strep agalactiae, ecoli, listeria

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36
Q

Causes of meningitis if above 1 month

A

Strep Pneumoniae, neisseria meningitis, HiB (if unVx)

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37
Q

Symptoms of meningitis in neonates

A

Very general. Lethargy, hypotonia, vom , poor appetite etc.
Then late on, bulging fontanelle, crying and seizure

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38
Q

Symptoms of meningitis in children

A

Our classics triad:
Fever
Headache
Neck stiffness

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39
Q

Suspect clinical diagnosis if meningitis. Next thing to do?

A

Obtain blood culture and LP

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40
Q

Diagnostic test for meningitis

A

LP and CSF analysis

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41
Q

When does imaging need to be done before LP (use FAILS mneumonic)

A

Focal neuro
Altered mental status
Immunocomp/ICP high
Lesions
Seizure

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42
Q

Vital treatment for meningitis. Then other Mx

A

Empiric antibiotics (if LP delayed, give anyway).
Fluids, secure airway if GCS < 8

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43
Q

Age < 1, empiric Tx for meningitis

A

Ampicillin and Gentamicin

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44
Q

Age > 1, empiric Tx for meningitis

A

Vancomycin and Cefotaxime/Ceftriaxone

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45
Q

When to give decamethosone when giving treatment for antibiotics?

A

If suspect strep Pneumoniae or HiB…. Avoid CK storm

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46
Q

Strep Pneumoniae meningitis Abx

A

Vancomycin

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47
Q

3rd gen cephalosporins can cover which 3 bac meningitis

A

HiB, Neisseria, Ecoli

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48
Q

Listeria and strep agalactiae meningitis Abx

A

Ampicillin

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49
Q

status epilepticus definition

A

Seizure lasting more than 5 mins (Tonic clonic), or sequence of seizures without gap in between. But if focal or absence, needs >10 mins.

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50
Q

Management of status epilepticus

A

IV benzos, or IM midazolam (if not IV access). Rectal or buccal diazepam are alternatives.

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51
Q

Management of status epilepticus if persistent (20-40mins)

A

IV fosphenytoin (or valproate, levetiracetam)

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52
Q

Management of status epilepticus, refractory (40-60 mins)

A

Repeat second lines, or induce coma

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53
Q

Mx of acute airway obstruction. 1st? If doesn’t work emergency measures?

A

Heimlich if full obs. Endotracheal tube, tracheostomy, Cricothyrotomy. CPR if unconscious

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54
Q

Invx for after an acute airway obs

A

Bronchoscope, CXR

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55
Q

Invx of acute bronchitis

A

Clinical diagnosis, can rule out other pathology with CXR, swabs etc.

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56
Q

Mx of acute bronchitis patient

A

Hydration, rest. Maybe symptomatic relief (paracetamol, antitussive, steroids, expectorants)

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57
Q

Invx for acute pharyngitis

A

Rapid strep test (and can do the centor score).

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58
Q

M-CENTOR score for strep pharyngitis

A

M must be older than 3 (3 looks like m)

C cough absent
E exudative tonsils
N node enlargement
T temperature elevation
OR young or old

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59
Q

CENTOR 4 or above

A

Empiric ABx

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60
Q

CENTOR 2 -4

A

Rapid test, throat culture

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61
Q

CENTOR 1 or less

A

No further Invx for strep

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62
Q

Mx for acute pharyngitis

A

Amoxicillin/clarithromycin for 10 days (recall sign if IM instead)

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63
Q

Diagnostic criteria for anaphylaxis

A
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64
Q

Mx for anaphylaxis

A

Epinephrine IM

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65
Q

Diagnosis of bronchiolotitis

A

Clinical Dx, can do nasopharyngeal swab for RSV (although not often done)

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66
Q

Main management for bronchiolitis

A

Supportive.
O2 if below 90%, IV fluids, nasal suction. Bronchodilators, steroids for severe encases only.

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67
Q

When do we hospitalise a bronchiolitis patient ?

A

Toxic, poor feeding, dehydration, respiratory distress, premature Hx, lung or heart disease, immunodef.

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68
Q

Management of mild Croup?

A

oral Dexamethasone

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69
Q

Management of moderate-to-severe Croup?

A

Inhaled epinephrine. (Quicker action than dexamethasone. ontop of CSs, IV fluids

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70
Q

Which children require confirmatory testing for CF

A

If they had positive newborn screening, first degree relative, has CF signs

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71
Q

The confirmatory testing signs of CF. Recall values for chloride

A
  1. Sweat test Cl of >60
  2. CFTR mutations and sweat test Cl >30
  3. +ve physiological testing
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72
Q

Mx of CF for lung preservation

A

High dose ibuprofen, bronchodilator, mucolytics, airway clearance technique

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73
Q

Mx of CF for nutrition

A

High energy diet, CREON, fat sol vitamins, NaCl intake

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74
Q

First thing to do in Epiglottiitis

A

Secure airway!! Before Invx.

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75
Q

How do we diagnose epiglottitis in acute setting

A

Clinically

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76
Q

When do we do the lateral cervical X-ray in epiglottitis?

A

If Dx unclear and patient stable

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77
Q

Treatment of epiglottitis (3 elements)

A

Empiric IV Abx, (Ceftriaxone), steroid, fluid resus

Or penicillin
Or flouroquinolone

78
Q

Once managed a patient with foreign body obstruction, what can be done to Invx?

A

X-RAY (2 view)

79
Q

Mx of acute airway obstruction/foreign body aspiration. Patient responsive and obstruction complete

A

Initiate back blows and then heimlich

80
Q

Mx of acute airway obstruction/foreign body aspiration. Patient responsive and obstruction incomplete/partial

A

Encourage coughing. If doesn’t work, do bronchoscopy

81
Q

Mx of acute airway obstruction/foreign body aspiration. Patient unresponsive

A

CPR and attempt laryngoscope guided retrieval. If needed, do surgical airway

82
Q

Prenatal test predication for NRDS

A

lecithin to sphingomyelin ratio

83
Q

Invx for NRDS (best 2)

A

CXR and ABG

84
Q

Management of NRDS

A

Endotracheal admin of surfactant within 2 hours. CPAP, and if resp insufficiency persists, do mechanical ventilation.

85
Q

Common pneumonia organisms in newborns

A

Ecoli, GBS, strep pneumoniae, HiB (unVx)

86
Q

Common pneumonia organisms in children (above 4wks)

A

Chlamydia trachomatis (babies), chlamydia pneumoniae (kids), RSV, mycoplasma (older children)… also plus strep

87
Q

High procalcitonin a sign of viral or bacterial pneumonia

A

Bacterial

88
Q

Diagnostic Invx for paediatric pneumonia

A

CXR

89
Q

Three potential Abx for paediatric pneumonia

A

Amoxicillin or Doxycycline or Clarithromycin (ACD)

90
Q

First invx in child with status asthmaticus or acute asthma exacerbation

A

PFTs

91
Q

When to do ABG in patient with suspected status asthmaticus

A

When PFTs show <50% predicted peak flow, or patient is clinically worsening

92
Q

Hypercapnia in patients with asthmaticus or acute asthma exacerbation… is a sign of what?

A

Impending respiratory failure

93
Q

Mx of status asthmaticus/ acute asthma exacerbation

A

ABCDE,
Albuterol
STeroids
Humidified air
Mg
Anticholinergic (SAMA-only if severe)

94
Q

Atypical pneumonia paeds patient. Tx?

A

Macrolide

95
Q

Best invx for ASD or VSD or PDA

A

Echo

96
Q

Asymptomatic ASD Mx

A

Watch and wait (likely spontaneously closes)

97
Q

Symptomatic ASD Mx

A

Patch repair Sx

98
Q

When to do Sx for VSD

A

If symptomatic and large.
Generally < 1 yo with pulm HTN signs
Older and medical therapy hasn’t worked

99
Q

Mx of PDA that is small and assymp

A

Observe

100
Q

Indications for closure if PDA

A

Symptomatic, or signs of HF/pulm HTN

101
Q

How to close the PDA

A

Indomethacin

102
Q

Best initial test for coarcted aorta

A

Blood pressure measurements

103
Q

Confirmatory test for coarcted aorta

A

Echo and Doppler

104
Q

Initial management of coarction

A

Infuse PGE1, then do surgery if indicated

105
Q

1st line Tx of pulmonic valve stenosis

A

Balloon valvuloplasty

106
Q

2nd line Tx of pulmonic valve stenosis

A

Commissurotomy (if balloon not possible)

107
Q

Ebsteins anomaly confirmation invx

A

echo

108
Q

Survival in patients with hypoplastic heart syndrome depends on what?

A

PDA

109
Q

Confirmatory test for hypoplastic left heart syndrome

A

Echo

110
Q

Prior to surgery for hypoplastic left heart syndrome… what must we do?

A

PGE1 infusion

111
Q

Prior to surgery for TC valve atresia… what must we do?

A

PGE1 infusion

112
Q

How to confirm a diagnosis of ToF

A

Echo

113
Q

Use of the hyperoxia test

A

Can distinguish between cardiac and pulmonary causes of cyanosis

114
Q

Prior to surgery for ToF… what must we do?

A

Infuse PGE1

115
Q

Mx of a Tet spell (multiple aspects)

A

O2, squat, morphine, fluids, B Blockers

116
Q

Medically how can we manage the HF in ToF

A

Digoxin and Loops, (not ACEI since can decrease SVR)

117
Q

Cyanosis in ToF vs Transposition

A

In ToF, cyanosis occurs on excertion.

118
Q

Prior to surgery for transposition of the great vessels … what must we do?

A

PGE1 infusion

119
Q

Total anomalous pulmonary venous return, associated with what diseases

A

Heterotaxy syndromes (with asplenia)

120
Q

Main association with persistent truncus arteriosus

A

DiGeorge

121
Q

Best invx (diagnostic) for appendicitis

A

CT abdomen

122
Q

Mx of appendicitis

A

Surgical removal, fluids, analgesic, NPO, Abx (cephalosporins)

123
Q

Best initial invx for intussusception

A

Abdominal X-ray

124
Q

Treatment of choice for intussusception

A

Air contrast enema (also an invx)

125
Q

Aside from air contrast enema, how to mx intussusception before

A

NG decompression and fluids IV

126
Q

Bell staging criteria used for?

A

Necrotising enterocolitis

127
Q

Stage 1 Bell NEC

A

Suspected. distended abdomen, vom, diarrhoea, reveal bleeding

128
Q

Stage 2 Bell NEC

A

Proven. Stage 1 + abdomen Tenderness. And see loops of GI lacking peristalsis

129
Q

Stage 3 Bell NEC

A

Advanced. DIC, perforation, sepsis etc.

130
Q

What FBC finding is associated with poor px?

A

<1500 neutropenia

131
Q

Overview of NEC mx

A

Supportive care, broad spectrum IV Abx, radio graphic monitoring and consider Sx

132
Q

Supportive care for NEC

A

NPO, only parental. NG decompression,

133
Q

Which Abx for NEC

A

Ampicillin, Gentamicin, Metronidazole

134
Q

When do we do Sx for NEC

A

Perforation, peritonitis, clinical worsening despite Tx

135
Q

What Sx can be done in NEC

A

Peritoneal drainage and laparotomy to excise necrotic bowel

136
Q

Best initial Invx to Dx celiacs

A

IgA tGT Ab with total IgA testing

137
Q

What acid base issue can we see in pyloric stenosis

A

Hypochloremic met alkalosis

138
Q

Initial invx for pyloric stenosis

A

US?

139
Q

Best invx for pyloric stenosis

A

Barium studies

140
Q

Mx of pyloric stenosis

A

Correct electrolytes, rehydrate, small often meals, elevate head.
Sx referral: Ramstedt Pyloromyotomy

141
Q

Initial workup for ALL

A

Clinical assessment, CBC and smear, LFTs, metabolic panel

142
Q

Diagnostic test for ALL

A

Bone marrow aspiration and biopsy (>20% blasts). MPO-, TdT+,

143
Q

Birth Vx

A

Hep B

144
Q

2mo Vx

A

Hep B, DTaP, HiB, Polio, pneumococcal, RV (HHPP Tap the RV)

145
Q

4 month Vx

A

(2mo Vxs except Hep B)

146
Q

6mo Vx

A

Same as 2mo, plus annual flu

147
Q

12-18 month Vx

A

DTaP, pneumococcal, HiB, MMR, Varicella, HepA (His 12-18 dispatched mumps Vx helped people)

148
Q

4-6 year Vx

A

DTaP, Polio, MMR, Varicella

149
Q

When is chicken pox not infectious

A

2 days before and 5 days after exanthem, or when crusts

150
Q

Best initial test for chicken pox

A

tzanck

151
Q

Best confirmatory test for Chickenpox

A

PCR

152
Q

Symptomatic treatment for chickenpox

A

Topical creams or oral histamines for pruitus

153
Q

When to give acyclovir in Chickenpox

A

Immunosurpressed , 1° infection in adults, patients on aspirin, unVx adolescents

154
Q

Rash for VZV

A

Pristine 1-2 days, then rash on trunk, spreading to face/head/extremities. Macula to papule to vesicle to crust

155
Q

When is a parvovirus patient infective

A

Before rash onset

156
Q

Rash in parvo?

A

Cold like, then red cheeks, maculopapular rash diffusely (becomes lacey/reticular

157
Q

When do we actually do lab tests to diagnose Parvo

A

If Dx unclear, usually can make it clinically

158
Q

Unclear clinical picture for Parvo, how to confirm?

A

Antibody testing

159
Q

Usual treatment for Parvo? Treatment for Parvo arthritis?

A

Usually self limited. Low dose prednisone for arthritis

160
Q

Gingivostomatitis rash

A

Gum and lip ulceration and erythema. Very painful.

161
Q

What is eczema herpeticum? How is it managed

A

HSV infx on top of eczema patient. Emergency and need oral/IV acyclovir

162
Q

Invx for HSV and need quick 1 hour result

A

Tzanck

163
Q

Invx to confirm HSV skin infx

A

Viral culture

164
Q

Invx for identifying HSV CNS infx

A

PCR

165
Q

Tx for HSV in immunocompenetent

A

Oral acyclovir 7-10 days

166
Q

Tx for HSV in immunocompromised

A

Oral acyclovir for 14-21 days

167
Q

Tx for HSV in severe cases (or cannot do oral)

A

IV acyclovir

168
Q

If clinically suspect IM (EBV), do what

A

Mono spot test

169
Q

IM suspected, monospot negative… how to move forward

A

Serology

170
Q

Symptomatic treatment for IM

A

Fluids, analgesic/antipyretic, lidocaine for throat pain, (steroids in complex cases),

171
Q

Advice to IM patient

A

Avoid physical activity for 3 weeks and physical sport for 4 weeks (spleen rupture risk)

172
Q

Signs of measles

A

Cough coryza, conjunctivitis, koplick spots….. then maculopapular rash behind ears spreading down

173
Q

Are lab tests needed for measles Dx

A

Yes

174
Q

Gold standard test to Dx measles

A

IgM

175
Q

Management of measles

A

VitA,

176
Q

How to diagnose subacute sclerosis panenceph

A

CSF (high IgG to measles), EEG

177
Q

Signs of Mumps

A

Few days prodrome, parotitis (bilateral) 2-10 days

178
Q

Should do lab tests for mumps suspicion.

A

Should try to, especially if atypical

179
Q

Potential ways to invx mumps

A

PCR or viral culture or IgM

180
Q

Mx for mumps?

A

Supportive:
Bed rest, paracetamol, fluids etc.

181
Q

Roseola I signs

A

High high fever (>40), nagayama spots, LNs,
Fever drops
Rose pink exanthem over trunk (blanches, unlike drug allergy rash)

182
Q

To diagnose Roseola

A

Clinical! Can do IgM or DNA test if uncertain

183
Q

Mx for Roseola

A

Antipyretic

184
Q

Rubella vs Measles for severity

A

Measles more severe

185
Q

Signs of Rubella

A

Prodromal for a few days, then post auricular LNs and forchheimer spots on soft palate. Then non congruent pink maculopapular rash spreading cranially to caudally. Spares hands

186
Q

Rubella is a clinical diagnosis, however when are lab tests needed

A

Patient who are at risk of complications and pregnant women

187
Q

Confirmatory lab test for rubella

A

IgM

188
Q

Mx for rubella

A

Symptomatic Tx

189
Q

baby less than 6mo.
Dose for anaphylaxis

A

100-150mg

190
Q

6mo-6yo
Dose for anaphylaxis

A

150mg

191
Q

6-12yo
Dose for anaphylaxis

A

300mg

192
Q

above 12yrs.
Dose for anaphylaxis

A

500mg

Finals (11 decks)

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