Paediatric Values & physio diff Flashcards
1
Q
Paeldiatric RR
A
Neonates : 30-50 tachypnoea =60+
1-2: 25-35. Tachypnoea = 50+
2-5: 20-35. tachypnoea = 40+
5-12: 20-25. Tachypnoea = 40+
12+: 15-20. Tachypnoea = 30+
2
Q
Paediatric HR
A
Neonates: 110- 160 bpm
1-2: 100-150 bpm
2-5: 95-140 bpm
5-12: 80-120 bpm
12+=: 60-100 bpm
3
Q
Paediatric systolic BP
A
Neonate: 70-90 (80)
1-2: 80-95 (87)
2-5: 80-100 (90)
5-12: 90-110 (100)
12+: 100-120 (110)
4
Q
Size and closure of anterior Fontenelle
Reasons for delayed closure
A
4-6 cm no real normal size
Closes 4 months to 2 years
delayed closure
Rickets
Hypothyroidism
hydrocephalus
Bulging/ tense
Increased ICP
ASD?
Crying
5
Q
Size and closure of the posterior Fontenelle
A
1-2 cm
closed at birth or up to 2 mo
Delayed closure
- preterm
- non. Comm hydrocephalus (
- hypothyroidism
- congenital infection
6
Q
When do primitive reflexes disappear
A
3-4 months
7
Q
What does HF CI
A
Immunisations
Lung puncture
8
Q
Difference in paediatric renal system
A
Smaller bladder
Shorter urethra
Lower GFR d/2 small gmoleruli
Decreased glucose absorption and physio glucosuria
9
Q
Paediatric voiding values
A
Volume of bladder
- Neonate: 50ml
- 1 year: 200ml
- Adults: 400ml
Daily urination vol
- 1 mo: 200 ml
- 1 yr: 600ml
Freq of urination
- Neonate: 20-25
- Infant: 15
10
Q
Formula for min paediatric urine output
A
1ml/kg/hour
Also ask how much they’ve drank
11
Q
Formula for BP in paeds
A
Systolic=90+ 2n
Diastolic = 60+n
N= age
12
Q
How does head circumference growt
A
increases 1 cm a month
35cm at birth
13
Q
Signs of dehydration
A
Sunken eyes
Reduced Turgidity
White tongue
Tachycardia
Increased hematocrit
Increased proteins
Ketones in urine
14
Q
Paediatric growth rate
A
1st year
- born 50cm
- 25 cm
- Triple weight
2nd year
-13 cm
3-puberty
- 6cm/ year
- 2kg/ year
15
Q
Formula for paediatric height
A
Height at 1 yr plus (age x 6)
16
Q
Def of child mortality
A
Deaths per 1000 live births
17
Q
Paediatric he values according to age
A
neonate: Hb less than 140g/L
1- 12 months:Hb less than 100g/L
1-12 years: Hb less than 110g/L.
18
Q
All haematological factors in paeds are lower except
A
Factor 8 and fibrinogen
19
Q
Anemia (hb) according to paediatric age
A
Neonate: below 140g/L
1mo-1yr: below 100g/L
1yr-12yr: below 110g/L
20
Q
How often to children poo
A
1st week - 4x/day
Breastfeeding varies-can go several days w/o
1 year -1-2x/day
21
Q
Causes of gowers sign
A
Juvenile dermatomyositis
DMD
22
Q
When does the left ventricle double in size
A
2 years of age
23
Q
Where is the foramen ovale ,and when does it close
A
3rd intercostal space betw/ the two atria
Closes at 2-16 weeks
24
Q
Where is the ductus arteriosus
When and how does it close
A
Connects pulm artery to aorta just below left subclavian
Closes around 2 days after birth
Bradykinin from lungs causes proliferation of SM
25
What are the umbilical arteries and what is their remnant
Continuation of fetal iliac arteries
Get blood
Bradykinin closure to become
MEDIAL UMBILICAL LIG
26
What is the umbilical vein and what does it become
Ligamentum teres next to,porta hepatis
27
What determine fetal cardiac output
HR as SV is limited by l s compliant ventricles
28
What is the only physiological newborn arrhythmia
Sinus bradycardia/ sinus arrhythmia
29
Causesnif reccurrnt wheeze
GERD
Viral episodic
Mx trigger
Asthma
Foreign body
Anaphylaxis
ASD if HF is present
30
Age of closure of ASD
Primum: Surgery at 3 years of age
secundum
Catheter device closure at 3–5 years of age
31
Age of closure of VSD
Small: None
Large (10–20% of cases)
Heart failure-Diuretics, captopril, calories
Surgery at 3–6 months of age
32
Closure of PDA
cardiac catheter occlusion at 1 year of age, ligation
33
Causes of fetal hydrops( accum of fluid in 2+ fetal compartments) ascites, pericardial effusion
Congenital complete heart block
Supra ventricular tachycardia ( HF, fluid build up and oedema)
34
Only CHD that doesn’t predispose INFECTIOUS endocarditis
Secundum ASD as it doesn’t cause valve pathologies
35
Dx for JIA
Sepsis and malignancy
SLE
Rheumatoid arthritis
36
Why do babies w/ Right to Left shunts present severely cyanosed a few days after birth
They have duct dependant circulation and once it closes oxygenates blood can’t enter the systemic circulation
37
Most common vasculitides in childhood
HSP
IgA vasculitis of Small vessels
Skin, Joint, GI, kidney
```
Sx= PASAG
Periarticular oedema
Arthralgia
Skin rash
Abdominal pain
Glomerulonephritis
```
38
Dx of haematuria
HSP
IGA NEPHROPATHY
APGN
RPGN
39
Dx protein uria (morning creatinine to protein ratio over 20mg/mmol
Transient: after exercise, infection
vasculitides
HSP, SLE
Orthostatic proteinuria
• Glomerular abnormalities
– Minimal change disease
– Glomerulonephritis
* Reduced renal mass in chronic kidney disease
* Hypertension
* Tubular proteinuria
TB
40
Causes of haematuria
Deformed cells
RBC casts
Non glom(bright red beginning or end)
UTI- most common bacterial, viral, tuberculosis
• Trauma to genitalia, urinary tract, or kidneys
• Stones
• Tumours
• Sickle cell disease
• Bleeding disorders
Glomerular(Brown)+ nephrotic synd
• Acute glomerulonephritis
-APGN( ASO; recent URTI;
RPGN( crescentic, kidney failure)
• Chronic glomerulonephritis
•Autoimmune
-IgA nephropathy, goodpasture, SLE; HSP
•Genetic-Alport syndrome:x linked recessive+deaf
41
Formula for bp
Neonate to 3yrs
S: 75+(2x age in months)
3 years and above
S: 100+(2x age in years)
42
Formula for predicted weight
Up to 6 months
Bw+(monthly age x 600)
6mo- 1 year
Bw+ (monthly age x 500) + 3600
After 1 year should be over 10kg
10kg + (2kg x years)
43
24 hour urine volume
800-2000ml
44
Atypical UTI
Atypical UTI is defined as any of the following:
Seriously ill.
Poor urine flow.
Abdominal or bladder mass.
Raised creatinine.
Septicaemia.
No response to suitable antibiotics within 48 hours. Infection with non-E.coli organisms.
45
Imaging of FOR UTI up to 6 mo
ACUTE Infec US:
Atypical and recurrent
6wk follow up US: yes even if they reapond to rx
MCUG: atypical and recurrent
46
Imaging of FOR UTI at 6 mo - 3 years
Acute infection US : atypical only
6 wk follow up US : recurrent only
47
Imaging of FOR UTI at 3 years plus
Atypical: US In acute infection
Recurrent:
6wk follow up US, & DMSA in 6mo
48
HUSHAT
Henolyric uraemic stndrome
haemolytic anemia, Acute KF, Thrombocytopenia
E.colings ecluzimab
Typical and atypical
49
Which KF is reversible
Acute kidney injury
```
Pre renal(hypovolemia- oliguria
Fluid replace & circ support
```
Renal:
Biopsy to dx RPGN- immunosuppr
HUSHAT- ecluzimab
Pyelonephritis- abiotic
Post renal: obstructive
Nephrostomy/ catheter
Rx metabolic abnorms
50
Rx of metabolic abnormalities
Acidosis-?sodium bicarb
Hyper phosphate- calcium carb
Hyperkal
check ECG- calcium gluconate
Glucose & insulin
Dialysis
51
Type 1 db RF
Dad> mum
Twin
Gestational db
Autoimmune diseases
-coeliac, hashimoto, R.A
52
Db types
Iron overload
CF
Gestational
Type 1&2
LADA
MODY
53
Keto acidosis sx
Acetone breath
Degydraton
Acute abdomen pain
Kussmaul breathing from acidosis
(deep and laboured)
elevated blood ketones
54
Dg of paed db
Random bg above 11.1 mmmol/l
Fasting above 7mmol/l
Ekevated HbA1c
55
Rx of type 1
Basal bolus -?short acting before meals
| Basal- evening long acting
56
Complic of sub cut injection
Lipohypertrophy
Rotate site
57
Ideal glucose lvl in db
4-7 mmmol
58
Conplications
Acute: hypoglycaemia,
Chronic
Small vessels
Retinopathy
Db nephropathy
Neuropathy
Large vessels
59
Reccurenr pneum
2+ episodes in a year
| 3 episodes of pneumonia ever
60
When can pmeunonia mimic other diseases
Upper lobe
-nuchal rigidity
Lower lobe
-abdominal pain
61
Pneumonia conplications
Empyema
Septarons
Pleural effusion
Meningitis
Osteomyelitis
62
Culture of pleural fluid pneum
Fine aspirarion
63
How is congenital hypothyroidism dg
Guthrie test- elevated TSH
| -doesnt dg pit dysfunc( low TSH)
64
Presentation of TSH def hypothyroidism
Sx progress w/ age
Low TSH- cold, dry, mottled, large tongue
Low ACTH- hypoglycemia
Low GH-
Micro penis
65
Causes of accquires hypothyroidism
2ndary to early graves or hashimoto
Goitre and is seen give thyroixine
66
Nebulzers
Humified air
67
Complication of croup
Pneumonia
Otitis media
68
1st line rx of hyperthyroidism
Propylthiouracil- disrupts T3&4 synth
Beta blocjets fir tachyK and tremor
Spontaneously resolve d/2 antithyroid immunoglobulins then causing hypothroidism
Thyroidectomy
Radioiodine rx
69
Propylthiouracil complicarions
Neutropenia- infextions -
70
How does neonatal hyperthyroidism occur
Trans placental transfer of thyroid stim immuno
71
Cause of CAH
Autosomal dom 21 hydroxylaze def
Causing cortisol def and ACTH elevation
80% also aldosterone def- salt crisis
72
Why are boys w/ increased risk of salt crisis at 1-3 wks
Sx of enlarged penis take time to diagnose usually missed But virulization easily detected early in girls
73
Cayses Of precocious puberty
CAH
Increased sensitivity in girls usually normal
74
Dg Constellation for CAH (5)
Elevated 17 hydroxylase precursor
Hyperpkalemia
Hyponatremia And hypoglycaemia
Acidosis
75
Dg of orimary / secondary addison
Same as CAH except imcreased ACTH on primary
Decreased ACTH and other pit hormones in secondary
76
Causes if asdisoj
Damage of hypo-pit axis
Meningococcal meningitis
TB
autoimmune
W/deawal if long term steroid usec
77
Rx if addisonian crisis
Reatore electrilytes
Life long glucocorticoid and mineral corticosteroids
78
Dx dg of cushings vs obesity
Obese babies are tall for mid parental height
79
Cushings dg
Loss of diurnal variation
Dexamathasone test
Imaging for tumors
80
Degine short stature
Height bekow 2nd centile/ 2SD below mean height
81
Causes of short stature
Ilfamilial
Constitutional dekag of puberty
```
Hormonal
-hypothyroidism
-cushings
-GH def
Nutritional deficiency
-malnutrition
-malabsorption
-chronic illness
```
Chromosomal
- turner
- down
82
Define premature puberty
Puberty before 8 girls pear shaped uterus on US
Idiopathic from ovary sensitivity
CAH
PIt adenoma
Before 9 in boys
83
Testicular enlargement in precocious puberty (4ml)
Unilateral: gonadal tumor
Bilateral: gonadotropin cause (pit adenoma/ bhcg from liver
None: non gonadotropin cause (CAH- pigment testes)
84
Define delayed
Abscence by 14 girls
15 boys more common
Familial
Caused by growth failure causes
And chromosomal
85
Facial nerve palsy dx
Brain stem lesion
- Concomitrant paralysis of CN8-
- cerebellar signs on same side as face
Concomittant HTN
-coarctation of aorta and renal failure
86
Def and causes of microcephaly
HC below 2nd centile
Familial
Autosomal recessive: assoc w/ developmental delay
Congenital infection
After damage to growing brain
-hypoglycaemia, perinatal hypoxia, meningitis
87
Macrocephaly
Above 98th centile
Familial
Increased ICP
88
Cause of neural tube defect
Failure of neural plate fusion in 1st 28 days of cenception
Dg on prenatal screen
Previous neural tube defect is high risk
Rx w/ folic acid
89
Tyoes if neural tube defects
Anencephaly: exposed brain- still born
Spina bifida: diastemaromylia on x ray
Meningocele: intact skin - chiari 2 hydrocephalus
Meningomyelocele: exposed neural plaque
Neurological repair
90
Rx of croup
Mild- oral dexamethasone
Severe
Nebulized epinephrineamd observation
Rifampin for fam prophylaxis
91
Rx of epiglottitis
Rifampin for fam proph
IV cephalosporin ( Ceftaxime)
92
Valve defect in primum
3 leaflet mitral valve- pansysltoic blowing murmur at lower left sterna, edge
93
Murmur of ASD
Systolic ejection
Wife and fixed split of S2
94
ECG of murmurs
Primum-superior QRS
Secondum- RBBB and right ADIS deviation
Large VSD( bigger than aorta)
Right axis deviation
95
VSD murmur
Small- loud pansystolic
Large
mall pansystolic.
Signs of pulm HTN
1)mid diastolic murmur mitral stenosis 2) loud p2
96
When is pulm stenosis heard on 1st day
Tetralogy of fallot
97
Absent femoral pulse
Sick child coarctation
Adult= radio-femoral delay
98
When is a continuous murmur w/ bounding pulse
PDA- increased PP
| Flow to pulm artery in both phases
99
When is carotid thrill
Aortic stenosis
100
LVH ON ECG
V2: tall R wave & deep S wave
V6: inverted T wave
101
RVH on ECG
V6: tall R wave
102
When is PT increased
DIC and Vit k def
103
APTT increased
Haemophilia mainly also VwD
104
Routes of HBV DNA virus transmission
Vertical by maternal infection -30% rx
Horizontal by fam - interferon rx 50%
Dialysis and blood transfusions
105
HEP B PROG by age
Neonates no sx but 90% become carriers
Children: hepatitis w/ HSM, ab pain, nausea
May become carries
50% carriers Bcome chronic
106
HEP B DG
Anti HBc antibodies
HBS surface antigen
107
What’s autoimmune hepatitis and sclerosis’s chola fit is
AI liver pathology: hepatitis’ cirrhosis, failure
W/ sclerosisimg cholangitis assoc w/ other GI AI diseases ( IBD)
Elevated igG, low complement
Rx w/ CS and ursodeoxycholic acid
108
Cause of Wilson disease
Autorcessivd deficiency of ceruloplasmin
```
Toxic buildup in
Liver
Kidneys
Eyes
Brain
```
Rx by zinc and penicillamine
