Paediatrics Flashcards
4 month old presents with mottled skin, irritable and photophobia.
1) Likely diagnosis
2) Skin change and causative organism
3) Septic screen and initial investigations
4) Diagnostic inx and what is seen in bacterial infection
5) Management for <3 months and > 3 months
1) Meningitis
2) Non-blanching purpuric rash (N. Meningitidis)
3) FBC, U/E, CRP, Clotting, venous gas + lactate, urine dipstick + cultures/sens. Blood cultures/sens
4) Lumbar Puncture. Protein raised, glucose low, Neutrophils raised, leucocytes slightly raised
5) <3 months = cefotaxime + amoxicillin. >3 months = ceftriaxone
4 Causative organisms in Meningitis and which one affects neonates
Listeria (Neonates/ <3 months) (gram pos, anaerobe)
Group B strep (<3 months) (gram positive, strep)
N. Meningitidis (gram pos, diplococcus)
S. Pneumonia
H. Influenzas (Gram neg coccus)
Complication of N Meningitidis and mx
hearing loss
dexamethasone 10mg every 6h (QDS) until cultures return and N Meningitidis rules out. Or continue.
Patient presents with 2 month hx of reduced weight baring on leg, Malaise and a salmon pink rash.
1) Likely diagnosis
2) Other symptoms
3) Inx and results
4) ANA status in specific diseases
5) Management
1) Juvenile Ideopathic arthritis
2) Lymphadenopathy, Weight loss, splenomegaly, Joint pain, muscle pain.
3) CRP, ESR, Ferratin, Platelets. All raised
4) Systemic disease = ANA and RF neg
Oligoarticular disease = ANA positive
5) Ibuprofen, Steroids, DMARDS
Patient presents with cracking lips, 5 days of fever and strawberry tongue.
1) Other possible symptoms that may be present.
Type of rash
2) Diagnosis
3) Inx
4) 2 Complications and management
1) Swollen hands and feet. Desquamination of skin on fingers, Maculopapular rash
2) Kawasaki
3) Anaemia, Leucocytosis, thrombocytosis, Hypoalbuminaemia, Raised liver enzymes.
4) Coronary artery aneurysm (IV immunoglobulin)
Thrombosis (High dose aspirin)
3yo presents with stridor, barking cough, fever and 2-3 days of coryza.
1) Likely differential and why.
2) Other symptoms specific to this disease
3) Infective causes
4) Management
1) Croup - 2-3 days of coryza and presence of cough
2) Low grade fever, horse voice, decreased feeding
3) Parainfluenza, influenza, RSV
4) Dex 150mcg/kg. If deteriorate then Nebulised adrenaline and oxygen
1) 3 differences between croup and epiglottitis
2) Cause of epiglottitis
3) Management of epiglottitis
1) Croup has a cough, develops over 2-3 days (not hours). Patients can still feed. Harsh and loud stridor
2) H. Influenza B (hib)
3) IV Ceftiaxone. Dex. Intubation and anaesthetist ready
Patient presents with difficulty breathing and eating. Low grade fever. Hyperinflated chest.
1) 3 signs of severe disease on examination
2) Admission criteria
3) Causative organism and time of year most common
4) Management
1) Chest recessions, mottled skin. Grunting. Floppy.
2) <3months. 50% reduction in feeding volume. Visible dehydration. RR>70. sats<90
3) RSV - october - February
4) Supportive. Encourage re-feeding. IV/NG tube
1) Moderate asthma attack criteria
2) Severe asthma attack criteria
3) Life-threatening asthma attack criteria
1) Peak flow >50%. non of the below features
2) Peak flow <50%. sats <92. Unable to complete sentences/eat. Signs of resp distress. RR > 40 in 1-5 years and > 30 in > 5 years. HR > 140 in 1-5 years and > 125 in > 5 years
3) Peak flow <33% sats < 92%. Silent chest. Low GCS. Exhaustion. Cyanosis.
1-4 Management stages of asthma in child <5
1) SABA
2) low dose ICS for 8 weeks, then stop, see if symptoms get worse. If they do = asthma.
3) Add one of either, LRA (Monteleukast) or ICS.
4) refer to specialist
1-4 management stages for asthma for child 5-12
1) SABA
2) ICS + SABA
3) ICS + SAMA + SABA (only cont sama if it works
4) Increase ics dose, add LAMA (theophylline).
1) How does cystic fibrosis present in new borns
2) How does CF present in older children.
3) Differential for CF - and what to ask in the family history?
4) Gold standard test for CF.
5) Management of CF.
1) Meconium ileus. Or picked up on newborn blood spot test
2) Failure to thrive, recurrent chest infections, pancreatitis. Steatorrhoea
3) Primary ciliary dyskinesia. “Is you mum your brother?” - those exact words. (Consanguineous parentage more commonly leads to PCD)
4) Sweat test
5) Daily chest physio. CREON tablets. Nedulised DNAse. Hypertonic saline nebs. Prophylactic fluclox. Genetic counselling. Fertility support. High calorie diet.
1) Congential heart defects risked by maternal rubella infection
2) 2 Cyanotic congenital heart conditions.
3) Patient presents with webbed neck, short stature, and weak femoral pulses. Likely condition?
4) Drug used to maintain patience of ductus arteriosus. When might this be needed
5) Arrhythmia associated with Ebstein’s anomaly
1) Tetralogy of fallot. PDA.
2) Ebsteins anomaly. ToF.
3) Turners syndrome –> Coactation of aorta
4) Prostoglandin E - Coarctation of aorta. ToF
5) Wolf-Parkinson-White syndrome
6 week old presents with FTF and poor feeding. SOB. On Auscultation there is loud machinery murmur
1) Likely diagnosis
2) how else can this disease present
3) Drug used to close PDA and when
1) PDA
2) Recurrent chest infections
3) Indamethacin - 1 week if no closure,
1) Definition of neonatal hypoglycaemia
2) Management options (2)
1) Not technically. But unofficial is <2.6mmol/mol
2) If well - encourage oral feeding.
If symptomatic - admit to neonates for 10% IV dextrose
Inx required for all babies born in breach presentation
USS pelvis and hips (hip dysplasia)
4yo boy presents with 3/52 hx of weight loss and polyuria and polydipsia. Now complaining of abdominal pain. Taken to ED with GCS 8.
1) What would you expect to see on the blood gas, given the likely diagnosis.
2) What initial management approach would you take + what fluids would you prescribe - would you have to do anything differently?
3) Complication of DKA in paeds. And management of this
4) Insulin infusion dosage
1) Metabolic acidosis. High Bicarb, high base excess. Possibly low CO2.
2) A-E approach. Resuscitation fluids at 10mL/kg in <10 min. (normal resuscitations fluids in paeds are 20mL/kg in <10min). Caution of cerebral oedema. Only give more fluid if clinically dry.
3) Cerebral oedema - low GCS, headache, bradycardia.
4) 0.1U/kg/hr. Once Blood glucose <14mmol.mol add dextrose 5% to fluids.
What are the paediatric maintenance fluids doses.
100mL/kg/24h for first 10kg
50mL/kg/24h for next 10kg
20mL/kg/24h for everything over 20kg.
1) 3 Causes for congenital TSH and aetiology.
2) Screening test for these, and the other diseases tested for.
3) Mx of Congenital hypothyroidism
1) Mal-descent of thyroid gland (developed world). Dyshormonogenesis (consanguineous parents). Iodine deficiency (most common world wide)
2) Guthrie test: CF, Sickle cell, Hypothyroid, inherited metabolic disease.
3) Levothyroxine 10mcg/kg then 5mcg/kg.
Unwell neonate has a blood test. Report shows hyponatraemia and hyperkalaemia and acidosis.
1) Likely cause?
2) presentation in a) neonate b) young child
3) Acute management and long term management
1) Adrenal insufficiency (addisons)
2) A) committing, lethargy, collapse, poor feeding. B) Abdo pain, cramps, pigmentation, Hypoglycaemia. TFT.
3) Acute management with fluids, fludrocortisone and hydrocortisone.
Long term management with hormonal replacement. + corrective surgery may be needing in women
1) Pathophysiology of congenital adrenal hyperplasia.
2) Presentation of a) neonate b) male c) female)
3) Management
1) Deficiency of 21-hydroxylase enzyme
2a) poor feeding, von, dehydration, arrhythmias
b) Tall, deep voice, big cock, small balls, early puberty.
c) Tall, oligomenorrhoea, early puberty.
3) Hormone replacement. Fludrocortisone and hydrocortisone
Causes of TFT
Low nutritional intake - maternal malnourished. neglect.
Difficulting feeding - cleft lip, pyloric stenosis
Malabsorption - CF, Coeliac, cows milk intolerance
Increased energy requirement - CHD, hyperthyroidism.
Metabolic disease
1) when to investigate UTIs in paediatrics. and what investigation.
2) How to inx damage post recurrent or atypical UTI.
1) Recurrent UTI (6 weeks post infection)
Any UTI under 6 months (within 6 weeks)
Atypical/proteus infection (during infection)
2) DMSA scan. 4-6 months post infection to assess damage
Causes of diarrhoea in children (8)
Overflow from chronic constipation coeliac IBS IBD Gastroenteritis Meckels diverticulum Cows milk intolerance Hyperthyroidism
