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
2
Q
Potential antibody testing for T1 DM patients
A
Anti GAD, anti islet cell,
3
Q
Other than insulin, what management should we give to diabetics (T1)
A
Routine screening and do Vx’s
4
Q
First invx for DKA
A
Glucose test
5
Q
General invx for DKA aside from glucose
A
ABG, urinalysis, workup for cause
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)
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.
8
Q
Hypoglycaemia level in diabetics vs non diabetics
A
Diabetics: <70
Non diabetics: <55
9
Q
Whipple triad for hypoglycemia
A
Low glucose, signs of low glucose, relief of symptoms when eat glucose
10
Q
Neurogenic/autonomic hypoglycaemic symptoms
A
SNS signs, tremor, pallor, tachycardia, sweating, palpitations.
PNS signs, hunger, parenthesia, N/V
11
Q
Neuroglycopenic hypoglycaemic symptoms
A
Agitated, confused, AMS, fatigue, seizure, somnolence (coma and death)
12
Q
First Invx for hypoglycemia
A
Glucose test
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
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.
15
Q
Is pregnancy still possible in Turners
A
Yes, with IVF, using donor oocytes and exogenous estradiol/progesterone
16
Q
3 elements to the diagnosis of Turners
A
Clinical. Low E. High FSH. Karyotype to confirm
17
Q
Two hormone therapies for Turners, and one important surgery
A
Estrogen/progesterone Tx, GH Tx, remove streak gonads
18
Q
EEG for absence seizures
A
3Hz spikes in all regions of the brain
19
Q
1st line for absent seizure
A
Ethosux (2nd line: valproate )
20
Q
3 main types of cerebral palsy (based on brain location affected)
A
Spastic (motor cortex), Dyskinetic (basal ganglia), ataxic (cerebellum)
21
Q
Main risk factor for cerebral palsy
A
Preterm and low birth weight
22
Q
Hand preference before age 1… is this a red flag for what?
A
Hemiplegia
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)
24
Q
Cure for Cerebral Palsy?
A
No. Just improve QoL
25
Mx for cerebral palsy
Therapy (physical, occupational, speech, educational, nutritional, social). Antispasmodics (botulinum, baclofen, dantrolene, benzodiazepines).
26
Most common cause of intellectual disability
Downs
27
First trimester tests results for downs fetuses
Low PAPP-A, high BHCG, nuchal translucency
28
Second trimester tests results for downs fetuses
BHCG and Inhibin high
Estriol and AFP low
29
If screening for downs indicates increased risk, what confirmatory tests can we do?
9-14 wks: Chorionic villus sampling
15-22 wks: amniocentesis
30
Simple vs complex febrile seizure
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)
31
Aim of diagnostic workup in simple febrile seizure.
Find cause (no specific workup)
32
diagnostic workup in complex febrile seizure? and the aim?
EEG and imaging needed! To find underlying cause
33
When do we give abortive therapy for febrile seizure
If complex, or if lasts >= 5 mins. Give IV diazepam
34
Mainstay treatment for febrile seizure
NSAID/paracetamol to reduce fever
35
Causes of meningitis if less than 1mo
Strep agalactiae, ecoli, listeria
36
Causes of meningitis if above 1 month
Strep Pneumoniae, neisseria meningitis, HiB (if unVx)
37
Symptoms of meningitis in neonates
Very general. Lethargy, hypotonia, vom , poor appetite etc.
Then late on, bulging fontanelle, crying and seizure
38
Symptoms of meningitis in children
Our classics triad:
Fever
Headache
Neck stiffness
39
Suspect clinical diagnosis if meningitis. Next thing to do?
Obtain blood culture and LP
40
Diagnostic test for meningitis
LP and CSF analysis
41
When does imaging need to be done before LP (use FAILS mneumonic)
Focal neuro
Altered mental status
Immunocomp/ICP high
Lesions
Seizure
42
Vital treatment for meningitis. Then other Mx
Empiric antibiotics (if LP delayed, give anyway).
Fluids, secure airway if GCS < 8
43
Age < 1, empiric Tx for meningitis
Ampicillin and Gentamicin
44
Age > 1, empiric Tx for meningitis
Vancomycin and Cefotaxime/Ceftriaxone
45
When to give decamethosone when giving treatment for antibiotics?
If suspect strep Pneumoniae or HiB…. Avoid CK storm
46
Strep Pneumoniae meningitis Abx
Vancomycin
47
3rd gen cephalosporins can cover which 3 bac meningitis
HiB, Neisseria, Ecoli
48
Listeria and strep agalactiae meningitis Abx
Ampicillin
49
status epilepticus definition
Seizure lasting more than 5 mins (Tonic clonic), or sequence of seizures without gap in between. But if focal or absence, needs >10 mins.
50
Management of status epilepticus
IV benzos, or IM midazolam (if not IV access). Rectal or buccal diazepam are alternatives.
51
Management of status epilepticus if persistent (20-40mins)
IV fosphenytoin (or valproate, levetiracetam)
52
Management of status epilepticus, refractory (40-60 mins)
Repeat second lines, or induce coma
53
Mx of acute airway obstruction. 1st? If doesn’t work emergency measures?
Heimlich if full obs. Endotracheal tube, tracheostomy, Cricothyrotomy. CPR if unconscious
54
Invx for after an acute airway obs
Bronchoscope, CXR
55
Invx of acute bronchitis
Clinical diagnosis, can rule out other pathology with CXR, swabs etc.
56
Mx of acute bronchitis patient
Hydration, rest. Maybe symptomatic relief (paracetamol, antitussive, steroids, expectorants)
57
Invx for acute pharyngitis
Rapid strep test (and can do the centor score).
58
M-CENTOR score for strep pharyngitis
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
59
CENTOR 4 or above
Empiric ABx
60
CENTOR 2 -4
Rapid test, throat culture
61
CENTOR 1 or less
No further Invx for strep
62
Mx for acute pharyngitis
Amoxicillin/clarithromycin for 10 days (recall sign if IM instead)
63
Diagnostic criteria for anaphylaxis
64
Mx for anaphylaxis
Epinephrine IM
65
Diagnosis of bronchiolotitis
Clinical Dx, can do nasopharyngeal swab for RSV (although not often done)
66
Main management for bronchiolitis
Supportive.
O2 if below 90%, IV fluids, nasal suction. Bronchodilators, steroids for severe encases only.
67
When do we hospitalise a bronchiolitis patient ?
Toxic, poor feeding, dehydration, respiratory distress, premature Hx, lung or heart disease, immunodef.
68
Management of mild Croup?
oral Dexamethasone
69
Management of moderate-to-severe Croup?
Inhaled epinephrine. (Quicker action than dexamethasone. ontop of CSs, IV fluids
70
Which children require confirmatory testing for CF
If they had positive newborn screening, first degree relative, has CF signs
71
The confirmatory testing signs of CF. Recall values for chloride
1. Sweat test Cl of >60
2. CFTR mutations and sweat test Cl >30
3. +ve physiological testing
72
Mx of CF for lung preservation
High dose ibuprofen, bronchodilator, mucolytics, airway clearance technique
73
Mx of CF for nutrition
High energy diet, CREON, fat sol vitamins, NaCl intake
74
First thing to do in Epiglottiitis
Secure airway!! Before Invx.
75
How do we diagnose epiglottitis in acute setting
Clinically
76
When do we do the lateral cervical X-ray in epiglottitis?
If Dx unclear and patient stable
77
Treatment of epiglottitis (3 elements)
Empiric IV Abx, (Ceftriaxone), steroid, fluid resus
Or penicillin
Or flouroquinolone
78
Once managed a patient with foreign body obstruction, what can be done to Invx?
X-RAY (2 view)
79
Mx of acute airway obstruction/foreign body aspiration. Patient responsive and obstruction complete
Initiate back blows and then heimlich
80
Mx of acute airway obstruction/foreign body aspiration. Patient responsive and obstruction incomplete/partial
Encourage coughing. If doesn’t work, do bronchoscopy
81
Mx of acute airway obstruction/foreign body aspiration. Patient unresponsive
CPR and attempt laryngoscope guided retrieval. If needed, do surgical airway
82
Prenatal test predication for NRDS
lecithin to sphingomyelin ratio
83
Invx for NRDS (best 2)
CXR and ABG
84
Management of NRDS
Endotracheal admin of surfactant within 2 hours. CPAP, and if resp insufficiency persists, do mechanical ventilation.
85
Common pneumonia organisms in newborns
Ecoli, GBS, strep pneumoniae, HiB (unVx)
86
Common pneumonia organisms in children (above 4wks)
Chlamydia trachomatis (babies), chlamydia pneumoniae (kids), RSV, mycoplasma (older children)... also plus strep
87
High procalcitonin a sign of viral or bacterial pneumonia
Bacterial
88
Diagnostic Invx for paediatric pneumonia
CXR
89
Three potential Abx for paediatric pneumonia
Amoxicillin or Doxycycline or Clarithromycin (ACD)
90
First invx in child with status asthmaticus or acute asthma exacerbation
PFTs
91
When to do ABG in patient with suspected status asthmaticus
When PFTs show <50% predicted peak flow, or patient is clinically worsening
92
Hypercapnia in patients with asthmaticus or acute asthma exacerbation… is a sign of what?
Impending respiratory failure
93
Mx of status asthmaticus/ acute asthma exacerbation
ABCDE,
Albuterol
STeroids
Humidified air
Mg
Anticholinergic (SAMA-only if severe)
94
Atypical pneumonia paeds patient. Tx?
Macrolide
95
Best invx for ASD or VSD or PDA
Echo
96
Asymptomatic ASD Mx
Watch and wait (likely spontaneously closes)
97
Symptomatic ASD Mx
Patch repair Sx
98
When to do Sx for VSD
If symptomatic and large.
Generally < 1 yo with pulm HTN signs
Older and medical therapy hasn’t worked
99
Mx of PDA that is small and assymp
Observe
100
Indications for closure if PDA
Symptomatic, or signs of HF/pulm HTN
101
How to close the PDA
Indomethacin
102
Best initial test for coarcted aorta
Blood pressure measurements
103
Confirmatory test for coarcted aorta
Echo and Doppler
104
Initial management of coarction
Infuse PGE1, then do surgery if indicated
105
1st line Tx of pulmonic valve stenosis
Balloon valvuloplasty
106
2nd line Tx of pulmonic valve stenosis
Commissurotomy (if balloon not possible)
107
Ebsteins anomaly confirmation invx
echo
108
Survival in patients with hypoplastic heart syndrome depends on what?
PDA
109
Confirmatory test for hypoplastic left heart syndrome
Echo
110
Prior to surgery for hypoplastic left heart syndrome… what must we do?
PGE1 infusion
111
Prior to surgery for TC valve atresia… what must we do?
PGE1 infusion
112
How to confirm a diagnosis of ToF
Echo
113
Use of the hyperoxia test
Can distinguish between cardiac and pulmonary causes of cyanosis
114
Prior to surgery for ToF… what must we do?
Infuse PGE1
115
Mx of a Tet spell (multiple aspects)
O2, squat, morphine, fluids, B Blockers
116
Medically how can we manage the HF in ToF
Digoxin and Loops, (not ACEI since can decrease SVR)
117
Cyanosis in ToF vs Transposition
In ToF, cyanosis occurs on excertion.
118
Prior to surgery for transposition of the great vessels … what must we do?
PGE1 infusion
119
Total anomalous pulmonary venous return, associated with what diseases
Heterotaxy syndromes (with asplenia)
120
Main association with persistent truncus arteriosus
DiGeorge
121
Best invx (diagnostic) for appendicitis
CT abdomen
122
Mx of appendicitis
Surgical removal, fluids, analgesic, NPO, Abx (cephalosporins)
123
Best initial invx for intussusception
Abdominal X-ray
124
Treatment of choice for intussusception
Air contrast enema (also an invx)
125
Aside from air contrast enema, how to mx intussusception before
NG decompression and fluids IV
126
Bell staging criteria used for?
Necrotising enterocolitis
127
Stage 1 Bell NEC
Suspected. distended abdomen, vom, diarrhoea, reveal bleeding
128
Stage 2 Bell NEC
Proven. Stage 1 + abdomen Tenderness. And see loops of GI lacking peristalsis
129
Stage 3 Bell NEC
Advanced. DIC, perforation, sepsis etc.
130
What FBC finding is associated with poor px?
<1500 neutropenia
131
Overview of NEC mx
Supportive care, broad spectrum IV Abx, radio graphic monitoring and consider Sx
132
Supportive care for NEC
NPO, only parental. NG decompression,
133
Which Abx for NEC
Ampicillin, Gentamicin, Metronidazole
134
When do we do Sx for NEC
Perforation, peritonitis, clinical worsening despite Tx
135
What Sx can be done in NEC
Peritoneal drainage and laparotomy to excise necrotic bowel
136
Best initial Invx to Dx celiacs
IgA tGT Ab with total IgA testing
137
What acid base issue can we see in pyloric stenosis
Hypochloremic met alkalosis
138
Initial invx for pyloric stenosis
US?
139
Best invx for pyloric stenosis
Barium studies
140
Mx of pyloric stenosis
Correct electrolytes, rehydrate, small often meals, elevate head.
Sx referral: Ramstedt Pyloromyotomy
141
Initial workup for ALL
Clinical assessment, CBC and smear, LFTs, metabolic panel
142
Diagnostic test for ALL
Bone marrow aspiration and biopsy (>20% blasts). MPO-, TdT+,
143
Birth Vx
Hep B
144
2mo Vx
Hep B, DTaP, HiB, Polio, pneumococcal, RV (HHPP Tap the RV)
145
4 month Vx
(2mo Vxs except Hep B)
146
6mo Vx
Same as 2mo, plus annual flu
147
12-18 month Vx
DTaP, pneumococcal, HiB, MMR, Varicella, HepA (His 12-18 dispatched mumps Vx helped people)
148
4-6 year Vx
DTaP, Polio, MMR, Varicella
149
When is chicken pox not infectious
2 days before and 5 days after exanthem, or when crusts
150
Best initial test for chicken pox
tzanck
151
Best confirmatory test for Chickenpox
PCR
152
Symptomatic treatment for chickenpox
Topical creams or oral histamines for pruitus
153
When to give acyclovir in Chickenpox
Immunosurpressed , 1° infection in adults, patients on aspirin, unVx adolescents
154
Rash for VZV
Pristine 1-2 days, then rash on trunk, spreading to face/head/extremities. Macula to papule to vesicle to crust
155
When is a parvovirus patient infective
Before rash onset
156
Rash in parvo?
Cold like, then red cheeks, maculopapular rash diffusely (becomes lacey/reticular
157
When do we actually do lab tests to diagnose Parvo
If Dx unclear, usually can make it clinically
158
Unclear clinical picture for Parvo, how to confirm?
Antibody testing
159
Usual treatment for Parvo? Treatment for Parvo arthritis?
Usually self limited. Low dose prednisone for arthritis
160
Gingivostomatitis rash
Gum and lip ulceration and erythema. Very painful.
161
What is eczema herpeticum? How is it managed
HSV infx on top of eczema patient. Emergency and need oral/IV acyclovir
162
Invx for HSV and need quick 1 hour result
Tzanck
163
Invx to confirm HSV skin infx
Viral culture
164
Invx for identifying HSV CNS infx
PCR
165
Tx for HSV in immunocompenetent
Oral acyclovir 7-10 days
166
Tx for HSV in immunocompromised
Oral acyclovir for 14-21 days
167
Tx for HSV in severe cases (or cannot do oral)
IV acyclovir
168
If clinically suspect IM (EBV), do what
Mono spot test
169
IM suspected, monospot negative… how to move forward
Serology
170
Symptomatic treatment for IM
Fluids, analgesic/antipyretic, lidocaine for throat pain, (steroids in complex cases),
171
Advice to IM patient
Avoid physical activity for 3 weeks and physical sport for 4 weeks (spleen rupture risk)
172
Signs of measles
Cough coryza, conjunctivitis, koplick spots….. then maculopapular rash behind ears spreading down
173
Are lab tests needed for measles Dx
Yes
174
Gold standard test to Dx measles
IgM
175
Management of measles
VitA,
176
How to diagnose subacute sclerosis panenceph
CSF (high IgG to measles), EEG
177
Signs of Mumps
Few days prodrome, parotitis (bilateral) 2-10 days
178
Should do lab tests for mumps suspicion.
Should try to, especially if atypical
179
Potential ways to invx mumps
PCR or viral culture or IgM
180
Mx for mumps?
Supportive:
Bed rest, paracetamol, fluids etc.
181
Roseola I signs
High high fever (>40), nagayama spots, LNs,
Fever drops
Rose pink exanthem over trunk (blanches, unlike drug allergy rash)
182
To diagnose Roseola
Clinical! Can do IgM or DNA test if uncertain
183
Mx for Roseola
Antipyretic
184
Rubella vs Measles for severity
Measles more severe
185
Signs of Rubella
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
Rubella is a clinical diagnosis, however when are lab tests needed
Patient who are at risk of complications and pregnant women
187
Confirmatory lab test for rubella
IgM
188
Mx for rubella
Symptomatic Tx
189
baby less than 6mo.
Dose for anaphylaxis
100-150mg
190
6mo-6yo
Dose for anaphylaxis
150mg
191
6-12yo
Dose for anaphylaxis
300mg
192
above 12yrs.
Dose for anaphylaxis
500mg
