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Phase 3a > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is most common cause of paediatric admission?

A

Infection

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2
Q

Where is commonest infection in children?

A

Respiritory tract

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3
Q

What group of children are in need of care for infeciton?

A

Younger ones

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4
Q

What is a challenge with viruses?

A

They can mimic bacterial infections

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5
Q

What to do with antibiotic decisions?

A

Assess, give as narrow spectrum as possible, then take samples to help advise in the future.

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6
Q

What are difficulties with Abx in children?

A

Tollerability, forulation, toxicities and pharmacokinedics dificult and studies are challenging and often done later

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7
Q

What is the problem with chickenpox in children?

A

Fever get broken skin, and then bacterial infection that can be serious

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8
Q

What kind of infections can happen after chicken pox?

A

Skin bone joint infections

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9
Q

Kawisaki disease what is the importance?

A

Most serious disease for complications, most common cause of aquired heart disease in children

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10
Q

What are diagnostic criteria for Kawisaki disease?

A

4/5 fever 5 days plus red swollen hands, fed swollen fee, rash involving body, red bloodshot eyes stomatitis

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11
Q

What is the link with inflammation and infection?

A

Infection can cause excessive inflammation and body usually has inflammatory response.

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12
Q

What is can fever indicate in children?

A

sepsis, bacterial, Immune diseases, inflammatory, travel

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13
Q

What investigations are needed for under 3 months fever?

A

FBC, Blood culture, CRP, urine culture other investigations

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14
Q

What to do investigated under 1 month with fever?

A

Lumbarpuncture FBC, bloood cluture CRP urine culture

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15
Q

What are the fauses of meningities or encephalitisi in under 3 months?

A

ecoli listeria, pneumonococcus, meningococcus

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16
Q

What are the casuitive organisms of meningitis or encephalitis in over 3 months?

A

Meningococcus pneumococcus haemophilus influenza non b

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17
Q

When is it likely to stop getting meningitis?

A

After 3 or 4 weeks

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18
Q

What tests do to look at immune competency?

A

immunoglobulin levels not so much IgG but the other immunoglobulins

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19
Q

What is immune difficicney presentation?

A

Can be an emergency, infections unusually ones or not clearing, IgG, can be presenstation with abnormal blood count with no infection

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20
Q

What are the types of immune congentitial issues?

A

Some cant make antibodies some cant make T cells, othere no neutrophils, some can’t make effective neutrophils.

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21
Q

What are most common immune defficienty?

A

Antibody defiecienceis, combined cellilar and andibodies then others

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22
Q

10 warning signs of immune deffiiceiny?

A

frequent infection, thrush and family history of it

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23
Q

What is treatment for immune defficeincy?

A

Prompt treatments, antivitrals and antibacterials

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24
Q

What is pasive immunisation?

A

Give you immunoglobulins to help fight off but give no memory

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25
Q

What are live vaccines?

A

MMR BCG nasal flu rotavirus

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26
Q

Look at which viruses are included for children?

A

7 in 1,

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27
Q

Look at which viruses are included for children?

A

7 in 1,

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28
Q

Why are vaccines in pregnancy?

A

for the mother bbut also passes on Immunoglobulines to the child when its been born

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29
Q

What is the impact of covid on vaccinations?

A

The vaccination rate dropped due to interruption with the process

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30
Q

What are the congenital or perinatal infection?

A

HIV maternal, Hep B, CMV, Rubella, HSV VZV more

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31
Q

What usually causes cardiorespiratroy arrest in adults?

A

Primary usually suddene unpredictable, VF or VF success depends on response

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32
Q

What is main cuase of cardiac arrest in children?

A

Usually hypoxia from respiratory failure, myocardial hypoxia results in bradycardia then asystole, neeed to prevent tis by spotting respiratory. The cardiac causes are primary such as congenital

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33
Q

What is causes for breathing problems?

A

Oxygenation or breathing

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34
Q

What is respiratory failure?

A

Mismatch of lung ventilation and perfusion causes reduced oxygenation, inadequate ventilation leads to increase psCO2

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35
Q

What to do for breathing assessment?

A

effort of breathingResp rate work of breathing extra noises, efficacy of breathing: chest expansion, auscultation, pxygemation, effect of breathing HR skin colour mental status

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36
Q

What is problem with respiratory rate measure?

A

If distressed, in pain of have fever it can go up

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37
Q

What happens in exhaustion for children breahting?

A

breathing slows and is pre-terminal sign

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38
Q

What are causes of low HR?

A

Respiratory depresssion from cerebral proble,s children with neuromuscular conditions that can affect breathing, fatigue

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39
Q

What are signs of increased effort of breathing?

A

Stridor wheeze, crackles

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40
Q

What is the level of oxygen when you have cyanosis?

A

less than 70%

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41
Q

wHAT IS NORMAL RANGE OF SPO2 TO AIM FOR?

A

94-98

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42
Q

What can affect spo2 reading?

A

High pco2 or movement

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43
Q

What can cause increased HR?

A

Infection hypoxia hypercarbia

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44
Q

What is Respiratory decompsensation?

A

Increase in resp rate or sudden fall in resp rate, exhaustion and drops GCS reduced interaction with caregivers
cant remover co2 or get on o2 fast enoug

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45
Q

Assessig circulatory state?

A

Pulse heart rate, Perfusions central peripheral target organ perfusion, blood pressure preload, urine output

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46
Q

Where to assess pulse in baby?

A

In femoral brachial more than radial or carotid

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47
Q

What can affect heartrate artifactually?

A

Fever pain anxiety anxiety and shock

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48
Q

What is most common heart arrhythmia in children?

A

SVT

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49
Q

What is normal cap refill time?

A

less than 2 sec

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50
Q

What are erly signs of cerebral hypoperfusion?

A

loss of interest in surroundings, irritablility agitation, late signs drowsiness loss of consciousness hypotonia

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51
Q

How to assess urine output in childerne?

A

Ask about changing nappy or use urinary catheter

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52
Q

What is compensated shock?

A

The arterial blood pressure is mainteanes

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53
Q

What is decompensated shock?

A

When blood pressure drops

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54
Q

What is AVPU?

A

alert voice response to pain or unresponsive

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55
Q

What is decorticate posturing?

A

Arms drawn to chest feed togetger

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56
Q

What is decerebrate posturing?

A

Exetended arms internal rotated legs

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57
Q

What is lowest GCS?

A

3

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58
Q

What is each section out of for GCS?

A

M1-6 E1-4 V1-5

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59
Q

What represents a sever neurological drop in GCS?

A

1 or 2 points can be a lot

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60
Q

What to look for in exposure of ABCDE assessment?

A

Respect dignity, rashes, injuries, environment temperature, equipment.

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61
Q

Ho to describe status fo child?

A

stable in failure decompensated or compensated

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62
Q

What is management of compensated respiratory failure?

A

Child friendly approach in parents arms, O2 therapy monitoring, specifica therapy reassess seek senior help

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63
Q

What to do in decompensated resp failure?

A

ABCDE approach open maintain airway,o2 15l/min bag mask ventilation, assess adequacy of centilation, reassess and monitor HR Pulse oximetry RR

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64
Q

What to do in compensated circulatory failure? assess airway oxygen, monitorpulse oximetry HR, RR and BP,

A

assess airway oxygen, monitorpulse oximetry HR, RR and BP, IV or IO access IO if cant get IV, Fluid bolus20ml/kg plasmalyte or o.9% NaCl, Reassess after any intervention,

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65
Q

What is probelem with giving fluid bolus sometimes?

A

Heart conditions that could cause overload as might need ionotropes instead

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66
Q

What proportion of baby is water?

A

75% preterm 90%

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67
Q

What is different about babys body to do with water?

A

Lose fluid faster, lowr response to thirst independance and glomerular filtration, increased surgface mass metabolism respiratory rate.

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68
Q

What categoris can causes of dehydration come into?

A

Decreased intake or absorption, Increased losses

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69
Q

What are the signs of dehydrateion?

A

Mild 5% thirst dry lips restlessness, irritibility, moderate, sunken yeses reduced turgor decreased urine output, severe cold mottled peropheries, hypotension, anuria, reduced consciousness

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70
Q

What is chronic fluid deprevation?

A

Falure to thrive malnutriotion, constipation, urinart tract infectiosn

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71
Q

What are best ways to replace fluids in less than 6 months?

A

Mothers milk, or formulas

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72
Q

What are the infant formula?

A

Hungry baby to reduce hunger, antireflux tickend fluids, lactose free, Cows milk protein allergty formula so can have hydrolyed fluids amino acid based, goat milk formula or soy formula from 6months

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73
Q

What are non oral types of nutrition?

A

Nasogastric orogastric, nasoduodenal and oriduodenal or can do Percutantiosu endoscopic gastrostomy, gastrostomy, jejunostomy

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74
Q

What is solution for malabsorption if GI tract isnt happened?

A

Central access

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75
Q

When to use fluids in children?

A

not dehydrates for surgery give maintenance, if they are mildly dehuydrated, maintenance plus deficit, FOr very sick maintenance defecit and bolus

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76
Q

What type of fluid do you use in neonates?

A

10% glucose in neonates.

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77
Q

What happens to fluid diven in neonates?

A

Increase almost every day

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78
Q

What to do to check not dilutiong blood?

A

Monitor electrolyes every day

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79
Q

How to estimate child weight?

A

(Age+4)*2 = Weight

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80
Q

What fluid do we do for children?

A

0.9% sodium chloride+5% glucose(+/- KCl 10-20mmol/500ml)

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81
Q

Why don’t start Potassium for children?

A

Need to know if they are in defecite and if they are urinating

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82
Q

What is the volume and rate for a child?

A

first 10 kg give 100ml/kg/24hr
next 10kg 50ml/kg
every other Kg 20ml/kg

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83
Q

What is easy way to remember fluids?

A

1L for first 10kg, .5L for second 10 kg plus 20ml* rest of weight

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84
Q

How to correct fluid deficit?

A

Mild dont correct, mild 5 percent, severe 10%.
Use deficit(%)10weight in Kg In litres
this is to add to the rate

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85
Q

When do you use fluid bolus?

A

When it’s an emergency

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86
Q

What fluid to use for fluid bolud?

A

Normal saline 0.9%

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87
Q

What is volume rule for bolus?

A

10mls/Kg

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88
Q

What to monitor in children on IV fluids?

A

RR and O2 sats, HR and BP, Temperature, Neurological status, Fluid balance, U&E

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89
Q

What type of diabetes do children often have?

A

Type 1 or genetic types

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90
Q

What are the 4 main symptoms of diabetes type 1?

A

Toilet thirsty, tired and thinner

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91
Q

Why is glycosuria bad?

A

Have a very high level of glucose in the blood if have in the urine

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92
Q

What is normal blood glucose?

A

fasting 3.5-5.6 postprandial <7.8 random glucose >11.1 if symptomatic or 22.2 if asymptomatic.
Fasting over>7.0*2, OGTT Peak>11.1 two hours after 75g oral glucose

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93
Q

What is normal ketones level?

A

above 0.6 is worrying

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94
Q

What are 3 things for Diabetic ketoacidosis?

A

Acidotic ketotic and hyperglycaemia

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95
Q

What leads to DKA?

A

Cells don’t get the glucose from insufficient or absent glucose, then break down fats and protein and this causes ketones. and glucacon is secreted so get more release of glucsoe as cells are in low

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96
Q

What happens in DKA physiologically symptoms and sings?

A

Insuling def and glugagon excess causes increase ketones and blood glucoses leading ot osmotic diuresis vomiting and fluid electrolyte deplletion that can case cellular dysfunction, cerebreal oedema and shock

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97
Q

What is management of DKA?

A

Fluids(be careful with fluid shifts), Insulin, Monitor glucose hourly, Monitor electrolytes, especially K+ and ketones-2-4 hourly, Very strict fluid balance hourly I/O hourly neruo obs.

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98
Q

How long to leave giving insulin in DKA and why?

A

1-2 hours and because causes more of a fluid shift

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99
Q

What are in new diagnosis bloods?

A

Antibodies, and other autoimmune disease and bloods

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100
Q

What are serious complications of DKA?

A

Cerebral oedema, Shock, hypokalaemia, aspiration, thrombus

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101
Q

What is normal DMT1 treatment?

A

basal bolus, so take long acting once a day and then bolus before they eat carbohydrates.

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102
Q

What is classed as hypoglycaemia in diabetic children?

A

4

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103
Q

What are symptoms of hypoglycaemia?

A

Irritable hungry nauseous shaky anxious sweaty palpitations pallor neuroglycopenic, confused drowsy heartn cisula problems headache slurred speech.

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104
Q

Hypomanagement diabetes?

A

Fast acting sugars glucose tablets glucose gel glucose containt food or drink, not chocolate
follow up wiht longer acting carbohydrate

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105
Q

How long should hypo correct?

A

15 mins

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106
Q

What is emergency treatment for hypoglycaemia?

A

Glucagon

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107
Q

How often if checkup for diabetes?

A

every 3 months

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108
Q

What to check for regular diabetes?

A

annual eye screen, feet, urine BP, Injection site and Annual bloods to screen for any other conditions

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109
Q

When should transition from paediatrics diabetes to adult?

A

from 12 when appropriate for them

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110
Q

Why are things different for adult diabetes?

A

More new things to deal with live living alone or other substances

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111
Q

Why are things different for adult diabetes?

A

More new things to deal with live living alone or other substances

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112
Q

What are the symptoms of juvenile idiopathic arthritis?

A

swollen stiff painful joint for 6 weeks or more and all other causes are ruled out

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113
Q

What do you need to rule out JIA?

A

Infection septic arthritis and malignancy

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114
Q

What is initial treatment for JIA?

A

Steroids injection of IV or oral

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115
Q

What is used for long term treatment of JIA?

A

methotrexate

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116
Q

What other medications are used for treatment resistant JIA?

A

Biological therapies, newer therapies, repeat steroids,

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117
Q

What are the complications of JIA?

A

Uveitis mechanical damage, side effects of MTX nausea lowered immunity

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118
Q

What can the effects of chronic illness be spit into?

A

Biological( delayed growth/ puberty), psycholgical ( sick role regression mental health vody image), social ( decreased independence, failure of peer relationships , poor school attendand and family dynamics)

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119
Q

What is important for JIA in teenagers?

A

Need to support transition to adult services and increased independance in care for own disease

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120
Q

What is a structure to ask people with JIA or any adolescent with chronic disease?

A

Home
Education
Activities
Drugs and alcohol
Depression and Suicide
Sexual health
Spirituality

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121
Q

What are implacations of children being small?

A

High surface area/volume ratio, so if we bring a small baby for a study room has to be bigger. smaller equipment needed, fit torso on a small plate,

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122
Q

What is a challenge with cooperation for radiology?

A

Hard to get children to stay still or cooperate with the scan. they are more scared for interventions. can’t do aspirates as easily.

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123
Q

What is play therapy for in radiology?

A

Try to let children get used to te idea of the scanner and help them do it

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124
Q

What is difference to anatomy in children?

A

Smaller, some bones are not ossified, growth plates,

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125
Q

What is the effect if growth plate is damaged?

A

The growth will slow or stop in that area.

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126
Q

What is a n apophysis?

A

An extra growth plates of bone for tendons to attach to with a muscle

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127
Q

What is the difference in bone structure in children?

A

The bones are flexible and plastic. so can get greenstick fractures that adults dont get

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128
Q

What is the use of fontanells in immaging?

A

They allow the ultrasound imaging of the brain.

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129
Q

Why is it more of a danger to radiate children?

A

Their cells are dividing so more sensitive to radiation changes.

130
Q

Which scans are best for children?

A

Ultrasound, MRI compliance is a challenge. CT nuclear medicine and PET are more of a challenge

131
Q

What to think about when requesting scans in children?

A

Why do you want it what is differential diagnosis, what am i trying to demonstrate will the child cooperate,

132
Q

What is growth like in children?

A

Gain in weight is not the only thing, Grow

133
Q

Why do we monitor growth?

A

It is narrowly defined in healthy children wiht adequate nutrition and emotionally supportiv enevironment and can show an underlying issue

134
Q

What affects growth?

A

Pregnancy related factors infections smoking, genetics, food, endocrine factors psycosocail factors

135
Q

Where do children grow bone?

A

At thegrowth plate, epyhysis

136
Q

What regulates bone growth?

A

Endocrine signals, nutrition, ECF inflammatory cytokines (hypoxia sepsis acidocsis acan all affect growth)

137
Q

How to assess growth?

A

Measure routine screening record on charts, interpretation action

138
Q

What to ensure with height measurement?

A

Backs to the backboard, hold head level shoes and socks off

139
Q

What can you measure in babies?

A

Head circumference, height and weight

140
Q

What is genetic target height?

A

average height of parenta +-7depending on boys or girls

141
Q

What are growth velocity charts like?

A

Fastest grwoth in 2-3 years then slows and get another growth spurt at puberty

142
Q

What affects eary growth the most?

A

Nutrition

143
Q

What affects mid childhood growht the most?

A

Endocrine factors

144
Q

What affects growth at puberty?

A

The closing of the growth plates from oestrogen

145
Q

Why do boys usually grow taller than girls?

A

They go through puberty later

146
Q

What are the common growth problems in children?

A

Failure to thrive, short stature and overgrowth

147
Q

What is likely to cause failure to thrive?

A

Vomitting diarrhoea dysmphic features,

148
Q

What are red flags in growth failure to thrive?

A

Weight more than 2 centils less than height. and

149
Q

What can cause short stature?

A

Phsycosocial, genetics, malnutrition, constitiunitonal idiopathic, enironmentalphsyical disease skeletal disease, turner’s syndroem, endocrine

150
Q

What are two causes of overgrowht?

A

with impared final heigh or with increased final height

151
Q

What can cause overgrowth with impaired final height?

A

precocous puberty, congenital adrenal hyperplasia, McCun-albright syndrome hyperthyroidism

152
Q

What is sequence of puberty in women?

A

Breast buds, pubic hair growth and height spurt and menarche

153
Q

What is the sequence of male puberty?

A

testicular enlargment pubic hair growth eight spurt

154
Q

What is the sequence of male puberty?

A

testicular enlargment pubic hair growth eight spurt

155
Q

When is delayed puberty?

A

14 years in bosy and 13 in girls

156
Q

WHat is precocious puberty?

A

less than 8 for girls less than 9 for men

157
Q

How to stage male puberty?

A

tanner stages, testicular size pubic hair,

158
Q

What is beginning of puberty in boys?

A

3mls testicle size exceeded

159
Q

What is used to stage women puberty?

A

tanner stages

160
Q

What is beginning of puberty in girls?

A

Palpable breast buds

161
Q

What is skeletal maturity?

A

shows Growth in compatison to chronological age.

162
Q

What does high bone age help in assessment?

A

Allow you to see what endocrine stage they are at

163
Q

Why might babies have a small period or breast bud?

A

There are high lebeld of GnRH in the body at birth efore they are born

164
Q

What is a limp?

A

Asymetric gait deviation from normal age-appropriate gait pattern

165
Q

What to ask in history for limp?

A

age (to look at age specific things), where is it painful how long for,

166
Q

What to ask in history for limp?

A

age (to look at age specific things), where is it painful how long for,

167
Q

What are common misleading factors in history?

A

Trauma is not always the cause of pain, the site may be refered

168
Q

How to examine limp?

A

Assess gait, look(attitude, swelling asymmetry, redness bruise rash, muscle wasting/atrophy) feel (Limb temperature, swelling effusion tenderness lymph nodes) move check for pain, characteristics of the movement muscle tone strength measure. inspection

169
Q

What is the attitude of a limb why is it important?

A

The position of the limb. This can give you ideas about swelling as body changes the position to be the least painful

170
Q

What is Galleazi test?

A

Tests for leg length discrepancy

171
Q

What scans can you order for a limp?

A

x-ray with two views, localised collection with ultrasound or MRI for malignancy or infection

172
Q

Red flags for limping children?

A

unable to weight bare, fever, systemic illness, severe pain, limp or pain worsening, pain waking at night, redness swelling and stifness, weight lsoss anorexia

173
Q

When to refer limp?

A

uncertainty of cause of limp, septic arthritis or osteomyelitis

174
Q

What is septic arthritis definition?

A

Infection of the joint, fever 38.5oC inability to weight bear, CRP>20mg/L WBC>12

175
Q

What is perthe’s disease?

A

Idiopathic asvascular necrosis of femoral head often 4 to 10 years old, femoral head will be damadged. wide neck fragmented head,

176
Q

What is slipped upper femoral epyphysis?

A

When the epiphysis moves from the head of the femur and get refered knee pain

177
Q

What is dodlers fracture?

A

Undisplacesd spirla fracture of lower third of the tibia

178
Q

What is transient synovitis of the hip?

A

Get synovial inflamation that comes and goes on its own often in 5 year olds,

179
Q

In under 3s what is most common causes of limp?

A

Septic artritis or Osteomyelitis, less likely transient synovitis

180
Q

What is codman triangle?

A

Periostial reaction creating a tringular shadown near a tumour

181
Q

What things can cause rashes in children?

A

Birthmarks and baby rashes
Viral rashes
Bacteria
Fungi and Yeasts
Protozoa
Insects
Humans

182
Q

Where is caverous haemangioma bad?

A

Having one near your eye or were it might knock or bleed or in airway.

183
Q

What are a flat persistent red areapresent from birth?

A

Capillarity haemangioma usually dont go away.

184
Q

What is a mongolian blue spot?

A

May look like bruises on dark skin?

185
Q

What are prodromal symptoms of shingles?

A

Itching or burning before the rash

186
Q

What is the measals symptoms?

A

Cough conjunctivitist coryza koplik’s spots looks like kawisaki disease

187
Q

What is the rash for rubella?

A

Rash starts on face vague lacy ill defined not itchy

188
Q

what is 5th disease,?

A

Slapped check parvovirus 19

189
Q

HHV6 what is it?

A

Mild rash very unhappy baby nonspecific rash

190
Q

What are the symptoms for coxsakie disease?

A

Sore lumps on hands feet or mouth. hand food an mouth disease

191
Q

What is exzema herpeticum?

A

Herpes infection in exzema ridden skin Medical emergency

192
Q

What causes warts and verrucas?

A

HPV rough edges.

193
Q

What is golden crusty rashes?

A

Staph aureus impetigo very contagiousWh

194
Q

What can cause cervical absecce pr lymphadeniti?

A

staphyloccocus infection

195
Q

What is a rorry with peeling skin?

A

Scalded skin syndrome from toxins

196
Q

What can mimmic meningococcal infection?

A

HSP

197
Q

What causes strawberry tongue, and redness sparing mouth?

A

Scarlet fever

198
Q

What is a genital rash with satelite regions?

A

Candida infections

199
Q

What causes cerebral calcification and retina damage?

A

Toxoplasma gondii

200
Q

What can cause familiall rashes?

A

Scabies

201
Q

What areas are important for paediatric histories?

A

Presenting complaint, HPC, Past medical hostory, perinatal history, Growth and developental history, drug and allergies history, immunisation history family history social history systemic enquiry.

202
Q

What to take in perinatal history?

A

Where were born, type of delivery, maternal diseases, what gestation weight, post natal problems, feeding,

203
Q

What is growth and developmental history?

A

How well they are developing compared to general age. When to walk, sit unsupported, fix and follow. Growth from growth charts schooling learning development

204
Q

What is different in family and social history in paeds?

A

Who is at home in the family, who is who, how many children are thre from same parents, family history (could be maternal pregnancy) things run in the family.
social who at home who looks after, do they live in tow houses, do they have social care involved, support network.

205
Q

What is important in adolescents?

A

HEADSS

206
Q

What is important with examination of a child?

A

observation, ensure the child is comfortable as possible, get down to their level,

207
Q

What vaccinations do children recieve?

A

Diptheria tetanus, polio, hep B haemophilus influenzae type b, whooping ough, rotavirus, Meningitis B penumococcal vaccine, Meningitis C MMR Flu vaccine, men ACWY HPV

208
Q

What vaccinations are given at 8 weeks?

A

6 in 1 (Tetanus, Diptheria, Polio, Hib (Haemophilius influenzae type b) Whooping cough, Hep B and Rotavirus and meningitis B

209
Q

What vaccinations are given at 12 weeks?

A

6 in 1 2nd dose, pneumococcal vacine and rotavirus 2nd dose

210
Q

What vaccinations are given at 16 weeks?

A

6 in 1 and men b

211
Q

When do children get the flu Jab?

A

2 to 10 years

212
Q

When do children get MMR and 4 in one preschool booster?

A

3 years 4 months

213
Q

What is in the 4 in one pre school booster

A

TDP and whooping cough

214
Q

What is a gelastic siezure?

A

A laughing siezure

215
Q

What is cataplexy?

A

A collapse caused by laughing or high emotional levels

216
Q

What is a UTI?

A

Growth of bacteria in urinary tract

217
Q

What is upper tract UTI?

A

Pyelonephritis often more ill with vomiting etc

218
Q

Why is UTI important in children?

A

quite common, 50% recurrence, 50% ave structural abnormaliry, can have long term complications

219
Q

What are the long term complicaations of UTI?

A

Kidney scarring, hypertension and CKD

220
Q

When to suspect UTI?

A

Younger than 3 months fevere vomit lethargy irritability, poor feeding failure to thrives lesss likely to be abdominal pain Jaundices haematuria, offensive urine

Older children, frequency dysuria, dysfunctional voiding changes to continence abdo pain loin tenderness, fever malais vomiting haematuria offensive cloudy urine.

221
Q

When to get a urine sample?

A

Fever with no focus, symptoms and signs of UTI, unexplained fever of 38 or higher, younder than 3 months with suspected UTI

222
Q

How to get urine sample?

A

Clean catch. or tell them what to do

223
Q

What is SPA?

A

suprapubic aspiration, inserta a needle to get a sample of urine.

224
Q

What does pseudomonas UTI indicate?

A

could be structural abnormality

225
Q

Who needs admitting?

A

less than 3 month olds, systemically unwell, significant risk factors

226
Q

How long do you treat lower UTI under 3 months?

A

3 days with no systemic illness

227
Q

What is treatment for upper UTI?

A

7-10 days oral antibiotics

228
Q

Who do you worry about with UTI?

A

Atypica or recurrent (two or more with systemic sympromts

229
Q

What is atypical UTI?

A

Speticaemia non ecoli, urine stream poor

230
Q

What are investiagation of UTI atypical?

A

Ultrasound of renal tract, MCUG micturatiny cystourethrogram catheterise the patient and see dye

231
Q

what does MCUG tell you?

A

Vesicoureteric reflux, bladder Posterior urethral valve

232
Q

How is vesicoureterc reflux grades?

A

How much the ureter is filled how much of the kidney is dialated and the ureter

233
Q

What is DMSA scan?

A

Radionuclide imaging, dimercaptosuccinic acid scan, relative renal function showing scaring

234
Q

when are children followed up?

A

All children under the age of 3 months, systemically unwell recurrent UTI

235
Q

What does swelling indicate?

A

Fluid is in the wrong areas

236
Q

What does swelling indicate?

A

Fluid is in the wrong areas

237
Q

What can casue oedeme?

A

Poor lymph drainage, turners syndrome, venous drainage or pressure, lowered oncotic pressure low albumin or brotein (malnutrition liver isssues gut or kidney loss), Salt and water retention kidney impared GFR heart failure

238
Q

What causes nephrotic syndrome?

A

The podocytes are letting protein through because they are swollen

239
Q

What is best way to get proteinuria measured?

A

Protein creatinine ratio

240
Q

What defines nephrotic syndrome?

A

Proteinuria, hypoalbuminaemia and periperal oedema

241
Q

What are risks of Nephrotic syndrome?

A

Thrombosis increased risk of infection from concentration of urine

242
Q

What are 3 types of nephrotic sndrome in children?

A

Congenital, steroid sensitive and steroid resistant NS

243
Q

What is presentation of steroid sensitive nephrotic ssndrome?

A

Normal BP macroscopic haematureia, normal renal function, no features to suggest nephritis responst to steroid

244
Q

What suggests steroid resistant nephtotic sndroem?

A

Haematuria impared kidney function,

245
Q

When is minimal change disease most likely?

A

In under 5s gets less likely as get older boys more than girls more common in asian subcontinet

246
Q

What is the problem wiht minimal change in childrne?

A

Frequent relapses 8/10 most grow out of it. 95 % grow out of it

247
Q

What is treatment of nephrotic syndrome?

A

Steroids prednisilone, supportime measures, sodium moderation diuretics Pen V

248
Q

What can define nephritic syndrome?

A

Haematuria, proteinuria, impared GFR, Salt and water retention

249
Q

What is post infections glomerulonephritis?

A

Gen infectionon skin or throat get group a strep and gent antigen antibody compleces that activate complement in the glomerulus

250
Q

What to investigate for post strep glomerulonephritis?

A

FBC U and E complement throat swabs

251
Q

What is manangment of post strep glomerulonephritis?

A

Fluid balane correction of imbalance dialysis if needed, penicillin to treat it

252
Q

What is prognosis for post strep glomerulonephritis?

A

Usually fully recover not recurrent no long term implication for renal function

253
Q

What is affected in HSP?

A

Skin joints gut kidneys

254
Q

What rash is HSP?

A

Papular rash with bumps on extensor surfaces

255
Q

What type of kidney issues can HSP cause?

A

Nephritis or Nephrotic

256
Q

What is HSP nephritis?

A

IgA deposition, variable renal presentation, haematuria, proteinuria, nephrotic, syndrome, acute nephritis, renal impairment, hypertension can get end stage renal disease

257
Q

Why is childhood malignancy important?

A

Common cause of death despite being quite rare

258
Q

What are challenges of childhood survial of malignancy?

A

New problems identifeid as late effects life long follow up needed

259
Q

What are the types of cancers in children?

A

Very few carcinomas, embryonal tumours are rare in adults but common in children Wilma neuroblastoma rhabdommysosarcoma leukaemia bone tumpurs and lumphomas

260
Q

What are the likely causes of childhood cancer?

A

Not usually genetic double hit theory genetic susceptibility and environmental change, mutation in oncogenes

261
Q

Why do children take a long time to get diagnosed with cancer?

A

It’s rare and symptoms could be quite rare

262
Q

How does cancer present?

A

Lymphadenopathy organomegaly soft tissue mass bone marrow filtration airways restriction

263
Q

What could be significant for malignanct causes?

A

Pale tired lump in neck early morning hheadache abnormal red reflex proptosis recurrent discarch ear

264
Q

When to consider malignancy?

A

challenge diagnosies, retake history consider if not getting better

265
Q

What does leukaemia present as?

A

Fever, fatigue, frequent infections, luymphadenopathy hepator and or splenomegaly anaemia bruising petechia, bone or joint pain, Blasts and pancytopenic

266
Q

What are investigation on leukaemia?

A

Blood film, serum chemistry CXR bone marrow aspirate lumbar puncture

267
Q

What is need for lumbar puncture?

A

To see if they have CNS disease as part of staging

268
Q

What are ALL treatment?

A

Induction consolidation interim maintenance, delayed intensification then maintenance. Maybe high risk patiets for haemopoetic stem cell transplantation

269
Q

What are symptoms of CNS tumours?

A

Headache, vomiting papilloedema squint focal neurology

270
Q

When to scan with headache?

A

Papilloedema, neuro signs, recurrent headache, vomitting short stature

271
Q

What is treatment for most brain tumours?

A

Resected

272
Q

When do you give radiotherapy in children brain tumour?

A

Serious later effects in under 3s

273
Q

When to suspect malignant lymphadenopathy?

A

Persistant, without infection, unusual site supraclaviculaar, fevere weight los enlarged liver/spleen CXR

274
Q

What can abdominal masses present with?

A

Child may present with mass or pain haematuria constipation hypertension weight loss

275
Q

What are most common abdominal masses?

A

Wilms tumour (eye metastisies) neuroblastoma

276
Q

What is neuroblastoma treatment?

A

surgery if resectable then chemotherapy immunotherapy

277
Q

What is wilms tumour treatment?

A

Chemotherapy before surgery then remove kidney. radioterapy for abdominal or pulmpnary disease

278
Q

What is retinoblastoma presentation?

A

Loss of red reflex

279
Q

What are some of the late effects of treatment?

A

Endocrine- growth development, intellectual, cardiac toxicity, renal toxicity fertility, psychological

280
Q

What is ADHD?

A

Inattentiveness hyperactivity and impulsiveness

281
Q

What causes ADHD?

A

Not sure but very high heritability, probably genetic

282
Q

Why are more boys found to have it than girls?

A

Girls present slightly differently as they can disguise it well

283
Q

What is the main concern with ADHD?

A

It is risky with impulsive behaviour that could be dangerous.

284
Q

What is pervasiveness for ADHD?

A

Should have symptoms in all aspects of their life not just at home or school

285
Q

How is ADHD diagnosed?

A

Connors questionaire for parent and patient,s chool observation and developmentla history

286
Q

What condition is important to look at with ADHD?

A

Autism specturm disorder substance misuse depression anxiety oppositional defiant disorder eating disorders

287
Q

What can the medication fo rADHD do?

A

improve ability to concentrate control impulses plan ahead and follow through with tasks. Might still ahve forgetfulness emotional problems social awkwardness. It doesn’t cure it just reduce symptoms

288
Q

What is the way ADHD medications work?

A

Sending neurone doesnt send enought transmitter, or receptors ma not getr onto receptors or they may get reabsorbed before they bind. The medications are stimulant or non-stimulants, tey target the rransmitters stimulants target dopamine, non-stimulants target norepinephrine can impreove impulsivity

289
Q

What are the stimulant profiles?

A

Can acti in 30-90 minutes and can last for 3 -12 hours depending on which one

290
Q

What are on stimulent profiles?

A

Takes 2 to 4 weeks to happen

291
Q

What are side effects of stimulants?

A

Loss of appetite trouble sleeping, uncommon side effects includ anxiety agitation headaches tics and psychosis

292
Q

What are side effects of atomoxetine?

A

Moodiness uncommon nausea loss ofappetite, sluggishmess

293
Q

What are side effects of alpha-2 adrenergics?

A

Sleepiness fatigue uncommon side effects loss of appetite drop in BP nausea

294
Q

What are the risks with stimulants?

A

Could cause weight loss and impact height. Use caution wiht heart problems

295
Q

What are the risks with atomoxetine?

A

Rare incidence of liver complications

296
Q

What is effectivenes of ADHD medications?

A

80% stimulants 50% for the non stimulants

297
Q

How to initiate ADHD treatment?

A

start once a day, then increase 3 xD then increase dose then switch to longer acting

298
Q

Why should we treat inflammatory conditions?

A

They cause damage to joints

299
Q

What is a TNF alpha inhibitor?

A

Infliximab adalimumab golimumab certrolizumab pegol etanercept

300
Q

What are the IL1 inhibitors?

A

anakinra

301
Q

What are IL 6 inhibitor?

A

Tocilizumab

302
Q

What is under juvenile idiopathic arthritis?

A

Oligoarticular persistent, polyarticular- RhFnegative, Polyarticular- RhF positie Oligoarticular extendied systemic arthritis psoriatic arthritis, enthesistis related arthritis

303
Q

What is JIA?

A

onset before 16th birthday, no identified underlying case persistent joint swelling or painful restriction of movement lasting at least 6 weeks

304
Q

What is oligoarticular JIA?

A

Fewer than 4 joints affected often knee ankle or knee chronic anterior uveitis

305
Q

What is poliarticular JIA?

A

Small jints of hands and feet more dammage to joints it is more agresssive,

306
Q

What is psoriatic JIA?

A

Polyarticular pattern of arthritis psoriasis may be present or may have psoriasis happens later, strong genetic link, and nail pitting dactylitis

307
Q

What is enthesitis related arthritis?

A

precursor to ankylosisng spondylitis,

308
Q

What is systemic arthritis?

A

auto inflammatory condition but mainly systemic presentation daily high spiking fever, lymphadenopathy rash, organomegaly,

309
Q

What is a way to examine young peoples msk system?

A

pGALS

310
Q

What can affect childhood development?

A

Biological social environmental factors

311
Q

What is the healthy child programme?

A

A way to keep track of children to development involces NIPE x2 and new baby review, 1 year old and 2 years old

312
Q

What do health visitor assessments do?

A

They can asses development with ASQ-3 questionaire to monitor helth developent and monitor growth then can reer on if needed

313
Q

what are the areas of evelopment?

A

Gross motor, fine motor/Vision, speech language and hearing, social/selfcare

314
Q

What is sequence for gross motor development?

A

Head control raises head to 45 degreees, sit without support, walks carrying toy running jumping throwing a ball, run tiptoe walk upstars throw a ballneed more

315
Q

What is the sequence for fine motor?

A

fix and follow, palmar grasp, hand to hand, inferior grip, object permanence,inferior pincer grip, crawling walking with hand hold stands alone tower of 3 cubes scribbles handednessneed more

316
Q

What is the sequence of speech language

A

startle to noise, respond to own name and mama dada, 2-3 single words recognition of objects. two words together two step comand need more

317
Q

What is the sequent of social development?

A

smile to parten, stranger danger, uses spoon well imitates every day activities , feeding spoon fork, dry in dayneed more

318
Q

What are growth motor red flags?

A

Lack ehad movement 4 months, sitting 12 months walking 18 months

319
Q

What are red flags for fine morot?

A

Not reaching for objects 6 months handedness by 18 months

320
Q

Red flags for speech and language?

A

No first words by 15 months

321
Q

What can cause childhood delay in development?

A

Genetics, factors in pregnancy MCA infarct, Exposure to drugs and alcohol Factors around birt prematurity birth asphixia Factors in childhood, conditions imparement environmental factors abuse neglect low stimulation

322
Q

Who might be involved in developmental problems?

A

SALT, Physiotherapy, OT, Audiology opthalmology, sleep workshop, MAST early years inclusions support SENCO, child learning disability team, local support groups the local offer.

Phase 3a (9 decks)

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