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Year 5 > Paediatrics 1 > Flashcards

Paediatrics 1 Flashcards

1
Q

Paediatric risk factors for an AKI

A
  • Nephro-urological, cardiac or liver disease
  • Malignancy or bone marrow transplant
  • Dependent on others for fluids: infants and learning disabilities
  • Medication
  • Dehydration (gastroenteritis)
  • Sepsis
  • Major surgery
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2
Q

AKI investigations

A
  • FBC, U&E
  • Urine dip
  • Urine microscopy
  • Urinary tract US
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3
Q

Haemolytic Uraemic Syndrome (HUS) is a triad of

A
  • microangiopathic haemolytic anaemia,
  • thrombocytopaenia
  • acute renal failure
  • Can cause bloody diarrhoea, haematuria or prroteinuria
  • Causes intrinsic AKI
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4
Q

Henoch Schonlein Purpura (HSP)

A

is a childhood vasculitis which is characterised by palpable purpura (non blanching rash) in the presence of at least one of the following:

  • Diffuse abdominal pain
  • Acute arthritis or arthralgia
  • Renal involvement (haematuria and/or proteinuria)
  • Biopsy showing predominant IgA deposition
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5
Q

Management of AKI

A
  • Stop ACEi/ARB and NSAID
  • Fluid challenge
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6
Q

Allergic rhinitis classification

A
  • intermittent (< 4 days/week or <4 weeks per year) or Persistent ( > 4 days/week and >4 weeks per year)
  • mild (normal sleep and daily activity) or moderate to severe (disrupts sleep and normal activities)
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7
Q

Allergic rhinitis symptoms

A
  • Nasal symptoms (rhinorrhea, itching, sneezing, blocked nose)
  • Eye symptoms (conjunctivitis, runny itchy eyes)
  • Can present with mouth breathing or chronic otitis media with effusion
  • “allergic salute” (from constant nose rubbing), Dennie- Morgan lines ( infraorbital line or fold from chronic rubbing)
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8
Q

Symptoms suggestive of allergic conjunctivitis

A

1 or more of the following symptoms for >1h on most days:

  • Symptoms associated with rhinitis
  • Bilateral eye symptoms
  • Eye itching
  • Red eye
  • No photophobia
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9
Q

Symptoms suggestive of allergic rhinitis

A

2 or more of the following symptoms for >1 hour most days

  • Watery rhinorrhea
  • Sneezing, especially paroxysmal
  • Nasal obstruction
  • Nasal pruritis
  • +/- conjunctivitis
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10
Q

Treatment of allergic rhinitis

A
  • Allergen avoidance if known
  • Antihistamines for mild. Sedating (cetirizine) or non-sedating (chlorphenamine)
  • Nasal steroids for moderate/severe (fluticasone)
  • Montelukast (LTRA) can be added to steroids
  • Immunotherapy is in sublingual and subcutaneous forms in severe cases
  • Allergic conjunctivitis: eye drops (sodium cromoglycate or olopatadine)
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11
Q

Causes of anaemia in infancy

A
  • Anaemia of prematurity: much more likely to become anaemic then term infants
  • Blood loss
  • Haemolysis: Haemolytic disease of the newborn (ABO or rhesus incompatibility), Hereditary spherocytosis, G6PD deficiency
  • Twin-twin transfusion
  • Physiological anaemia of infancy

Physiological anaemia of infancy: dip in haemoglobin at 6-9 weeks

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12
Q

Causes of anaemia in older children

A
  • Iron deficiency: diet
  • Blood loss: menstruation
  • Rare causes: sickle cell anaemia, thalassaemia, leukaemoa, hereditary spherocytosis
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13
Q

Causes of microcytic anaemia

A
  • TAILS
  • T–Thalassaemia
  • A–Anaemia of chronic disease
  • I–Iron deficiency anaemia
  • L–Lead poisoning
  • S–Sideroblastic anaemia
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14
Q

Causes of normocytic anaemia

A
  • 3 A’s and 2 H’s
  • A–Acute blood loss
  • A–Anaemia of Chronic Disease
  • A–Aplastic Anaemia
  • H–Haemolytic Anaemia
  • H–Hypothyroidism
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15
Q

Causes of macrocytic anaemia

A
  • Megaloblastic: B12 and folate deficiency
  • Normoblastic: Alcohol, Reticulocytosis (haemolytic anaemia or blood loss), Hypothyroidism, Liver disease. Drugs i.e. azathioprine
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16
Q

Signs and symptoms of anaemia

A
  • Iron deficienct anaemia: Koilonychia, Angular chelitis, Atrophic glossitis
  • Brittle hairandnailscan indicate iron deficiency
  • Jaundiceoccurs inhaemolytic anaemia
  • Bone deformitiesoccur inthalassaemia
  • General: pale skin, conjunctival pallor, tachycardia, raised respiratory rate
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17
Q

Anaphylaxis symptoms

A
  • Airway: Swollen lips/tongue, sneezing
  • Respiratory: Wheezing, shortness of breath
  • Cardiovascular: Tachycardia, hypotension/shock, angioedema
  • Gastrointestinal: Abdominal pain, diarrhoea, vomiting
  • Dermatological: Urticaria, pruritis, flushed skin
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18
Q

Initial management of paediatric anaphylaxis

A
  • Immediate administration of adrenaline (1:1000, IM) repeat every 5 minutes if no improvement
  • Removing the trigger if possible
  • Early call for help
  • Placing the patient in a supine position and raising their legs
  • Managing the airway and administering high flow oxygen
  • IV fluids if patient is in shock
  • Hydrocortisone when not urgent
  • Attaching the patient to monitoring equipment
  • Antihistamines, such as oralchlorphenamineorcetirizine
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19
Q

Follow up management of anaphylaxis paeds

A
  • Monitor for 6-12hrs
  • Counselling on the use of adrenaline auto-injectors
  • A supply of two auto-injectors
  • Written advice
  • A referral to the local allergy service for follow-up
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20
Q

Amount of adrenaline to give in paeds anaphylaxis

A
  • Child <6 months: 100-150 micrograms
  • Child 6 months to 6 years: 150 micrograms
  • Child 6-12 years: 300 micrograms
  • Child >12: 500 micrograms
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21
Q

Appendicitis children

A

Children who are younger or have a retrocaecal/pelvic appendix are more likely to present in an atypical way

Appendicitis is uncommon in children under 4 years old but in this group often presents with perforation

22
Q

Symptoms of appendicitis

A
  • Loss of appetite (anorexia)
  • Nausea and vomiting
  • Rovsing’s sign(palpation of theleft iliac fossacauses pain in theRIF)
  • Guardingon abdominal palpation
  • Rebound tendernessis increased pain whenquicklyreleasingpressure on the right iliac fossa
  • Percussion tenderness
  • Central abdominal pain which moves to the RIF
  • Have more atypical symptoms
23
Q

Asthma key features

A
  • Clinical diagnosis
  • Usually difficult to do spirometry in children <7 years old
  • Normal spirometry does not exclude asthma but an obstructive picture ( FEV1/FVC ratio <80%, At least 12% increase to FEV1 post salbutamol ) or a high exhaled Nitric oxide measurement ( >20 ppb) support the diagosis
24
Q

Asthma symptoms

A
  • intermittent cough, wheeze and/or exercise induced symptoms
  • Wheeze : continuous high pitched musical sound coming from the chest
25
Q

Acute asthma general management

A
  • Maintain oxygen saturations between 94-98% with high flow oxygen if necessary.
  • Administer inhaled salbutamol
  • Proceed to nebulised salbutamol if necessary
  • Add nebulised ipratropium bromide
  • If O2 saturations remain <92%, add magnesium sulphate
  • Add intravenous salbutamol if no response to inhaled therapy
  • If severe or life-threatening acute asthma is not responsive to inhaled therapy, add aminophylline
  • All patients should receive steroids, given IV only if the patient is unable to take the dose orally
  • If the patient is not responding to salbutamol or ipratropium, consult with a senior clinician
26
Q

Moderate acute asthma attack

A
  • Able to talk in sentences
  • SpO2 >92%
  • PEF >50% best or predicted
  • In children >5: heart rate <125/min, respiratory rate <30/min
  • In children 1-5: heart rate <140/min, respiratory rate <40/min
27
Q

Severe asthma attack

A
  • SpO2 <92%
  • PEF 33-50% best or predicted
  • Too breathless to talk or feed
  • Heart rate: >125 (>5 years), >140 (1-5 years)
  • Respiratory rate: >30 breaths/min (>5 years), >40 (1-5 years)
  • Use of accessory neck muscles
28
Q

Life threatening asthma attack

A
  • SpO2 <92%
  • PEF <33% best or predicted
  • Silent chest
  • Poor respiratory effort
  • Agitation
  • Altered consciousness
  • Cyanosis
29
Q

Treatment for children with mild to moderate acute asthma

A
  • Bronchodilator therapy: give a beta- 2 agonist via a spacer (for a child <3 years use a close fitting mask). Give 1 puff every 30-60 seconds up to a maximum of 10 puffs. If symptoms are not controlled repeat beta-2 agonist and refer to hospital
  • Steroid therapy: should be given to all children with an asthma exacerbation, treatment should be given for 3-5 days
  • Will need regular nebulisers (salbutamol) until able to maintain oxygen saturation above 94% in air and clinically the work of breathing improves at which point can be switched to an inhaler via a space
30
Q

Treatment for severe exacerbation of asthma

A
  • Oxygen via facemask
  • Nebulised salbutamol; 5mg
  • Consider Prednisolone 30-40mg or IV Hydrocortisone 4mg/kg
  • If poor response add nebulised Ipratropium Bromide 250mg
  • Will need regular nebulisers (salbutamol) until able to maintain oxygen saturation above 94% in air and clinically the work of breathing improves at which point can be switched to an inhaler via a space
30
Q

Investigations for asthma

A
  • <5: clinical diagnosis
  • > 5: offer investigations every 6-12 months if unable to perform initially
  • Initially: spirometry with bronchodilator reversibility. This is enough to diagnose
  • 2nd line: FeNO (>35) and Peak flow variability (20%). If one is positive can suspect asthma and start treatment
31
Q

Treatment for life threatening asthma

A
  • Oxygen
  • Nebulised salbutamol 5mg plus Ipratropium Bromide 250micrograms
  • Consider IV Hydrocortisone 4mg/kr or 100mg
  • Discuss with consultant paediatrician
  • Will need regular nebulisers (salbutamol) until able to maintain oxygen saturation above 94% in air and clinically the work of breathing improves at which point can be switched to an inhaler via a space
32
Q

Complete control of asthma is defined as

A
  • No daytime symptoms
  • No night-time awakening due to asthma
  • No asthma attacks
  • No need for rescue medication
  • No limitations on activity including exercise
  • Normal lung function (FEV1 and/or peak expiratory flow (PEF) > 80% predicted or best)
  • Minimal side-effects from treatment
33
Q

Steps of asthma treatment children aged 5-16

A
  1. Newly diagnosed asthma: SABA
  2. Not controlled by step 1 or Newly diagnosed asthma with symptoms >=3/week or night time waking= SABA + paediatric low dose ICS
  3. SABA + paediatric low dose ICS + LTRA
  4. SABA + paediatric low dose ICS + LABA. Stop LTRA
  5. SABA + switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a paediatric low-dose ICS
  6. SABA + paediatric moderate dose ICS MART
34
Q

Steps of asthma treatment children <5

A
  1. Newly diagnosed: SABA
  2. Not controlled on previous step OR newly diagnosed asthma with symptoms >=3/ week or night time waking= SABA + an 8 week trial of paediatric MODERATE dose ICS
  3. SABA + paediatric low dose ICS + LTRA
  4. Stop the LTRA and refer to an paediatric asthma specialist
35
Q

ICS trial

A

After 8-weeks stop the ICS and monitor the child’s symptoms:

  • if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely
  • if symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy
  • if symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8‑week trial of a paediatric moderate dose of ICS
36
Q

Features of Atopic dermatitis and eczema

A
  • itchy, erythematous rash
  • repeated scratching may exacerbate affected areas
  • in infants the face and trunk are often affected
  • in younger children, eczema often occurs on the extensor surfaces
  • in older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
37
Q

Management of eczema

A
  • avoid irritants
  • simple emollients= large quantities should be used. The emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid.
  • Thin emollients: E45, Diprobase cream, Aveeno cream
  • Thick, greasy emollients: 50:50 ointment, Diprobase ointment
  • topical steroids
  • wet wrapping= large amounts of emollient (and sometimes topical steroids) applied under wet bandages
  • in severe cases, oral ciclosporin may be used
38
Q

The steroid ladder from weakest to most potent

A
  • Mild: Hydrocortisone 0.5%, 1% and 2.5%
  • Moderate: Eumovate (clobetasone butyrate 0.05%)
  • Potent: Betnovate (betamethasone 0.1%)
  • Very potent: Dermovate (clobetasol propionate 0.05%)
39
Q

Behavioural difficulties: Externalisation disorders

A
  • Outward behaviour like aggression, defiance, hyperactivity and impulsivity
  • Examples: ADHD, Oppositional Defiant Disorder (ODD) and Conduct disorder
  • ODD: exhibit a pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least six months. For example, frequent temper tantrums
  • Conduct disorder: repetitive patterns of behaviour where social norms/rules are violated. May be aggressive towards people or destroy property
40
Q

Behavioural difficulties: Internalising disorders and management

A
  • Examples: anxiety disorders. mood disorders
  • Inward focused behaviours like depression, anxiety and social withdrawal

Management= CBT and psychotherapy, no medical treatment available

41
Q

ADHD risk factors

A

prematurity, low birth weight, low paternal education, prenatal smoking, maternal depression.

42
Q

ADHD inattention symptoms

A
  • Does not follow through on instructions
  • Reluctant to engage in mentally-intense tasks
  • Easily distraction
  • Finds it difficult to sustain tasks
  • Finds it difficult to organise tasks or activities
  • Often forgetful in daily activities
  • Often loses things necessary for tasks or activities
  • Often does not seem to listen when spoken to directly
43
Q

ADHD: Hyperactivity/impulsivity symptoms

A
  • Unable to play quietly
  • Talks excessively
  • Does not wait their turn easily
  • Will spontaneously leave their seat when expected to sit
  • Is often ‘on the go’
  • Often interruptive or intrusive to others
  • Will answer prematurely, before a question has been finished
  • Will run and climb in situations where it is not appropriate
44
Q

How many criteria do you need for ADHD

A
  • ADHD is a condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent.
  • There has to be an element of developmental delay and symptoms must be present for up to 6 months.
  • For children up to the age of 16 years, six of these features have to be present;
  • 17 or over, the threshold is five features.
  • Four times as common in boys, normally diagnosed between 3 and 7.
  • Symptoms are present in 2 or more setting i.e. home or school. Some symptoms should be present before 12
    Following presentation, a ten-week ‘watch and wait’ period should follow to observe whether symptoms change or resolve. If they persist then referral to secondary care is required. Parents can attend education and training programmes
45
Q

ADHD drug therapy

A
  • Last resort, only available to 5 and above
  • Methylphenidate is first line in children and is initially given on a six-week trial basis. In children, weight and height and blood pressure should be monitored every 6 months. Can cause growth retardation, weight loss, tachycardia and hypertension.
  • If there is inadequate response, switch to lisdexamfetamine;
  • Dexamfetamine should be started in those who have benefited from lisdexamfetamine, but who can’t tolerate its side effects.
  • All these drugs are potentially cardiotoxic, perform a baseline ecg before starting treatment
46
Q

Management of ADHD

A
  • Simple behaviour management: reward charts, positive redirection, 1-2-3 reward visuals and self imposed concentration breaks.
  • Therapy: CBT, behavioural therapy and psychoeducation
  • Extra support at school
  • Medical management: methylphenidate or amphetamine
47
Q

Complications of ADHD

A
  • Lower educational and employment attainment
  • Poor self-esteem
  • Criminal behaviour
  • Relationship issues
  • Sleep disturbance
  • Substance abuse
  • Road traffic accidents
  • Self-harm
48
Q

Potential causes of speech delay

A

hearing impairment, global development delay, autism spectrum disorder, specific language disorders, neglect, attachment disorder, selective mutism.

49
Q

Autism epidemiology

A

is three to four times more common in boys than girls, around 50% of children with ASD have an intellectual disability

Year 5 (24 decks)

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