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Paeds High Yield Review > Paediatric Values & physio diff > Flashcards

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+

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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

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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)

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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

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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
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6
Q

When do primitive reflexes disappear

A

3-4 months

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7
Q

What does HF CI

A

Immunisations

Lung puncture

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8
Q

Difference in paediatric renal system

A

Smaller bladder

Shorter urethra

Lower GFR d/2 small gmoleruli

Decreased glucose absorption and physio glucosuria

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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
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10
Q

Formula for min paediatric urine output

A

1ml/kg/hour

Also ask how much they’ve drank

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11
Q

Formula for BP in paeds

A

Systolic=90+ 2n

Diastolic = 60+n

N= age

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12
Q

How does head circumference growt

A

increases 1 cm a month

35cm at birth

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13
Q

Signs of dehydration

A

Sunken eyes

Reduced Turgidity

White tongue

Tachycardia

Increased hematocrit

Increased proteins

Ketones in urine

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14
Q

Paediatric growth rate

A

1st year

  • born 50cm
  • 25 cm
  • Triple weight

2nd year
-13 cm

3-puberty

  • 6cm/ year
  • 2kg/ year
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15
Q

Formula for paediatric height

A

Height at 1 yr plus (age x 6)

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16
Q

Def of child mortality

A

Deaths per 1000 live births

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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.

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18
Q

All haematological factors in paeds are lower except

A

Factor 8 and fibrinogen

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19
Q

Anemia (hb) according to paediatric age

A

Neonate: below 140g/L

1mo-1yr: below 100g/L

1yr-12yr: below 110g/L

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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

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21
Q

Causes of gowers sign

A

Juvenile dermatomyositis

DMD

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22
Q

When does the left ventricle double in size

A

2 years of age

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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

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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

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25
Q

What are the umbilical arteries and what is their remnant

A

Continuation of fetal iliac arteries

Get blood

Bradykinin closure to become
MEDIAL UMBILICAL LIG

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26
Q

What is the umbilical vein and what does it become

A

Ligamentum teres next to,porta hepatis

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27
Q

What determine fetal cardiac output

A

HR as SV is limited by l s compliant ventricles

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28
Q

What is the only physiological newborn arrhythmia

A

Sinus bradycardia/ sinus arrhythmia

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29
Q

Causesnif reccurrnt wheeze

A

GERD

Viral episodic

Mx trigger

Asthma

Foreign body

Anaphylaxis

ASD if HF is present

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30
Q

Age of closure of ASD

A

Primum: Surgery at 3 years of age

secundum
Catheter device closure at 3–5 years of age

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31
Q

Age of closure of VSD

A

Small: None

Large (10–20% of cases)
Heart failure-Diuretics, captopril, calories
Surgery at 3–6 months of age

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32
Q

Closure of PDA

A

cardiac catheter occlusion at 1 year of age, ligation

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33
Q

Causes of fetal hydrops( accum of fluid in 2+ fetal compartments) ascites, pericardial effusion

A

Congenital complete heart block

Supra ventricular tachycardia ( HF, fluid build up and oedema)

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34
Q

Only CHD that doesn’t predispose INFECTIOUS endocarditis

A

Secundum ASD as it doesn’t cause valve pathologies

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35
Q

Dx for JIA

A

Sepsis and malignancy

SLE

Rheumatoid arthritis

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36
Q

Why do babies w/ Right to Left shunts present severely cyanosed a few days after birth

A

They have duct dependant circulation and once it closes oxygenates blood can’t enter the systemic circulation

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37
Q

Most common vasculitides in childhood

A

HSP
IgA vasculitis of Small vessels
Skin, Joint, GI, kidney

Sx= PASAG
Periarticular oedema
Arthralgia
Skin rash 
Abdominal pain 
Glomerulonephritis
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38
Q

Dx of haematuria

A

HSP

IGA NEPHROPATHY

APGN

RPGN

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39
Q

Dx protein uria (morning creatinine to protein ratio over 20mg/mmol

A

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

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40
Q

Causes of haematuria

Deformed cells
RBC casts

A

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

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41
Q

Formula for bp

A

Neonate to 3yrs
S: 75+(2x age in months)

3 years and above
S: 100+(2x age in years)

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42
Q

Formula for predicted weight

A

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)

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43
Q

24 hour urine volume

A

800-2000ml

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44
Q

Atypical UTI

A

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
Q

Imaging of FOR UTI up to 6 mo

A

ACUTE Infec US:
Atypical and recurrent

6wk follow up US: yes even if they reapond to rx

MCUG: atypical and recurrent

46
Q

Imaging of FOR UTI at 6 mo - 3 years

A

Acute infection US : atypical only

6 wk follow up US : recurrent only

47
Q

Imaging of FOR UTI at 3 years plus

A

Atypical: US In acute infection

Recurrent:
6wk follow up US, & DMSA in 6mo

48
Q

HUSHAT

A

Henolyric uraemic stndrome
haemolytic anemia, Acute KF, Thrombocytopenia

E.colings ecluzimab

Typical and atypical

49
Q

Which KF is reversible

A

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
Q

Rx of metabolic abnormalities

A

Acidosis-?sodium bicarb

Hyper phosphate- calcium carb

Hyperkal
check ECG- calcium gluconate
Glucose & insulin
Dialysis

51
Q

Type 1 db RF

A

Dad> mum
Twin
Gestational db

Autoimmune diseases
-coeliac, hashimoto, R.A

52
Q

Db types

A

Iron overload

CF

Gestational

Type 1&2

LADA

MODY

53
Q

Keto acidosis sx

A

Acetone breath

Degydraton

Acute abdomen pain

Kussmaul breathing from acidosis
(deep and laboured)

elevated blood ketones

54
Q

Dg of paed db

A

Random bg above 11.1 mmmol/l

Fasting above 7mmol/l

Ekevated HbA1c

55
Q

Rx of type 1

A

Basal bolus -?short acting before meals

Basal- evening long acting

56
Q

Complic of sub cut injection

A

Lipohypertrophy

Rotate site

57
Q

Ideal glucose lvl in db

A

4-7 mmmol

58
Q

Conplications

A

Acute: hypoglycaemia,

Chronic

Small vessels
Retinopathy
Db nephropathy
Neuropathy

Large vessels

59
Q

Reccurenr pneum

A

2+ episodes in a year

3 episodes of pneumonia ever

60
Q

When can pmeunonia mimic other diseases

A

Upper lobe
-nuchal rigidity

Lower lobe
-abdominal pain

61
Q

Pneumonia conplications

A

Empyema

Septarons

Pleural effusion

Meningitis

Osteomyelitis

62
Q

Culture of pleural fluid pneum

A

Fine aspirarion

63
Q

How is congenital hypothyroidism dg

A

Guthrie test- elevated TSH

-doesnt dg pit dysfunc( low TSH)

64
Q

Presentation of TSH def hypothyroidism

A

Sx progress w/ age

Low TSH- cold, dry, mottled, large tongue

Low ACTH- hypoglycemia

Low GH-

Micro penis

65
Q

Causes of accquires hypothyroidism

A

2ndary to early graves or hashimoto

Goitre and is seen give thyroixine

66
Q

Nebulzers

A

Humified air

67
Q

Complication of croup

A

Pneumonia

Otitis media

68
Q

1st line rx of hyperthyroidism

A

Propylthiouracil- disrupts T3&4 synth

Beta blocjets fir tachyK and tremor

Spontaneously resolve d/2 antithyroid immunoglobulins then causing hypothroidism

Thyroidectomy

Radioiodine rx

69
Q

Propylthiouracil complicarions

A

Neutropenia- infextions -

70
Q

How does neonatal hyperthyroidism occur

A

Trans placental transfer of thyroid stim immuno

71
Q

Cause of CAH

A

Autosomal dom 21 hydroxylaze def
Causing cortisol def and ACTH elevation
80% also aldosterone def- salt crisis

72
Q

Why are boys w/ increased risk of salt crisis at 1-3 wks

A

Sx of enlarged penis take time to diagnose usually missed But virulization easily detected early in girls

73
Q

Cayses Of precocious puberty

A

CAH

Increased sensitivity in girls usually normal

74
Q

Dg Constellation for CAH (5)

A

Elevated 17 hydroxylase precursor

Hyperpkalemia

Hyponatremia And hypoglycaemia

Acidosis

75
Q

Dg of orimary / secondary addison

A

Same as CAH except imcreased ACTH on primary

Decreased ACTH and other pit hormones in secondary

76
Q

Causes if asdisoj

A

Damage of hypo-pit axis

Meningococcal meningitis

TB

autoimmune

W/deawal if long term steroid usec

77
Q

Rx if addisonian crisis

A

Reatore electrilytes

Life long glucocorticoid and mineral corticosteroids

78
Q

Dx dg of cushings vs obesity

A

Obese babies are tall for mid parental height

79
Q

Cushings dg

A

Loss of diurnal variation

Dexamathasone test

Imaging for tumors

80
Q

Degine short stature

A

Height bekow 2nd centile/ 2SD below mean height

81
Q

Causes of short stature

A

Ilfamilial

Constitutional dekag of puberty

Hormonal
-hypothyroidism
-cushings
-GH def
Nutritional deficiency 
-malnutrition
-malabsorption
-chronic illness

Chromosomal

  • turner
  • down
82
Q

Define premature puberty

A

Puberty before 8 girls pear shaped uterus on US
Idiopathic from ovary sensitivity
CAH
PIt adenoma

Before 9 in boys

83
Q

Testicular enlargement in precocious puberty (4ml)

A

Unilateral: gonadal tumor

Bilateral: gonadotropin cause (pit adenoma/ bhcg from liver

None: non gonadotropin cause (CAH- pigment testes)

84
Q

Define delayed

A

Abscence by 14 girls

15 boys more common

Familial

Caused by growth failure causes

And chromosomal

85
Q

Facial nerve palsy dx

A

Brain stem lesion

  • Concomitrant paralysis of CN8-
  • cerebellar signs on same side as face

Concomittant HTN
-coarctation of aorta and renal failure

86
Q

Def and causes of microcephaly

A

HC below 2nd centile

Familial

Autosomal recessive: assoc w/ developmental delay

Congenital infection

After damage to growing brain
-hypoglycaemia, perinatal hypoxia, meningitis

87
Q

Macrocephaly

A

Above 98th centile

Familial

Increased ICP

88
Q

Cause of neural tube defect

A

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
Q

Tyoes if neural tube defects

A

Anencephaly: exposed brain- still born

Spina bifida: diastemaromylia on x ray

Meningocele: intact skin - chiari 2 hydrocephalus

Meningomyelocele: exposed neural plaque

Neurological repair

90
Q

Rx of croup

A

Mild- oral dexamethasone

Severe
Nebulized epinephrineamd observation

Rifampin for fam prophylaxis

91
Q

Rx of epiglottitis

A

Rifampin for fam proph

IV cephalosporin ( Ceftaxime)

92
Q

Valve defect in primum

A

3 leaflet mitral valve- pansysltoic blowing murmur at lower left sterna, edge

93
Q

Murmur of ASD

A

Systolic ejection

Wife and fixed split of S2

94
Q

ECG of murmurs

A

Primum-superior QRS
Secondum- RBBB and right ADIS deviation

Large VSD( bigger than aorta)

Right axis deviation

95
Q

VSD murmur

A

Small- loud pansystolic

Large
mall pansystolic.
Signs of pulm HTN
1)mid diastolic murmur mitral stenosis 2) loud p2

96
Q

When is pulm stenosis heard on 1st day

A

Tetralogy of fallot

97
Q

Absent femoral pulse

A

Sick child coarctation

Adult= radio-femoral delay

98
Q

When is a continuous murmur w/ bounding pulse

A

PDA- increased PP

Flow to pulm artery in both phases

99
Q

When is carotid thrill

A

Aortic stenosis

100
Q

LVH ON ECG

A

V2: tall R wave & deep S wave

V6: inverted T wave

101
Q

RVH on ECG

A

V6: tall R wave

102
Q

When is PT increased

A

DIC and Vit k def

103
Q

APTT increased

A

Haemophilia mainly also VwD

104
Q

Routes of HBV DNA virus transmission

A

Vertical by maternal infection -30% rx
Horizontal by fam - interferon rx 50%
Dialysis and blood transfusions

105
Q

HEP B PROG by age

A

Neonates no sx but 90% become carriers

Children: hepatitis w/ HSM, ab pain, nausea
May become carries

50% carriers Bcome chronic

106
Q

HEP B DG

A

Anti HBc antibodies

HBS surface antigen

107
Q

What’s autoimmune hepatitis and sclerosis’s chola fit is

A

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
Q

Cause of Wilson disease

A

Autorcessivd deficiency of ceruloplasmin

Toxic buildup in
Liver
Kidneys
Eyes 
Brain

Rx by zinc and penicillamine

Paeds High Yield Review (9 decks)

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