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FRCEM SBA > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the calculation to estimate paediatric weight?

A

(age in years + 4 ) x 2

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2
Q

When is the DTaP vaccine given?

A

2 months, 3 months, 4 months, 3-5 years and 13-18 years

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3
Q

When is the MMR vaccine given?

A

12 months and 3-5 years

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4
Q

When is the polio vaccine given?

A

2months, 3 months, 4months + 3-5 years

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5
Q

When is Men B vaccine given?

A

2 months, 4 months, 12 months

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6
Q

When is MEN with C + W135 + Y given?

A

13-15 years

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7
Q

When is the rotavirus vaccine given?

A

2 months + 3 months

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8
Q

What are risk factors for sudden infant death syndrome? (8)

A
  1. Passive smoking
  2. Male
  3. Winter
  4. Sleeping prone
  5. Premature babies
  6. Twins
  7. Co-sleeping
  8. Lower socio-economic status1
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9
Q

What must we ensure in ED in cases of sudden infant death syndrome? (6)

A
  1. Clear documentation - weight, condition of baby. Any marks from procedures
  2. Retain clothes and bedding and put in paper bag
  3. Ensure blood/urine/skin samples taken (inborn errors of metabolism)
  4. If twin/siblings council on preventative measures
  5. Cancel all hospital appointments
  6. Inform police will be in contact as matter of course
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10
Q

What 3 things must be present to diagnose BRUE?

A
  1. < 1 year
  2. <1 mins
  3. Sudden return to baseline
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11
Q

What 4 signs/symptoms characterise a BRUE (need at least one of these)

A

1, Cyanosis/pallor
2. Absent/irreg breathing
3. Increased or decreased tone
4. Altered GCS

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12
Q

Which low risk factors might allow a BRUE to be managed as an outpatient? (5)

A
  1. Over 60 days old
  2. Born over 32 weeks
  3. No CPR from healthcare professional
  4. 1st event
  5. < 1min
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13
Q

What is the management for infected umbilical cord?

A

IV abx
Refer paeds

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14
Q

What are the serious causes of neonatal jaundice? (7)

A
  1. Rh haemolytic disease
  2. ABO incompatibility
  3. Congenital spherocytosis
  4. G6PD deficiency
  5. CMV infection
  6. Hypothyroidism
  7. Biliary atresia
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15
Q

How much of a babies birth weight is expected to be lost by week one and when should they regain it?

A
  1. 10%
  2. Week 2
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16
Q

How well patients with inborn errors of metabolism present?

A
  1. Early
  2. Very unwell
  3. Can appears septic but no cause found
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17
Q

What biochemical abnormalities will patients with inborn errors of metabolism present with?

A
  1. Raised lactate
  2. Hypoglycaemia
  3. Raised ammonia
  4. Acidosis
  5. Ketonuria
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18
Q

How should patients with inborn errors of metabolism be managed immediately?

A
  1. IV dextrose - nil oral until which disease it is
  2. Early bloods very useful
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19
Q

In neonates what is milia?

A

Rash with white papules - benign and self limiting

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20
Q

What is erythema toxicum?

A

Neonatal rash - erythematous lesions with central white vesicles.
Benign and self limiting

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21
Q

What is a monilial infection?

A

Nappy rash infected by candida albicans
Erythema of flexures

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22
Q

What is seborrhoeic dermatitis

A

Erythematous, greasy rash involving nappy area/occipute and behind ears. Can become infected with candida

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23
Q

How is seborrhoeic dermatitis treated?

A

Nyastatin

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24
Q

How should temperature be measured in babies <4 weeks?

A

Electronic axilla thermometer

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25
Q

How should temp be measured in children 4 weeks to 5 years?(3 options)

A
  1. Electronic axilla thermometer
  2. Chemical dot thermometer
  3. Infra-red tympanic thermometer
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26
Q

Under what age should babies have full septic work up?

A

3 months

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27
Q

What are the signs are different in herpes simplex encephalitis compared with other meningo-encephalitis in children?

A
  1. Focal neurology
  2. Focal seizures
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28
Q

What does a rapid decrease in temp post anti-pyretics show?

A

Nothing - do not use response to anti-pyretics decide severity of illness

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29
Q

What investigations should babies under 3 months with a fever have? (7)

A
  1. FBC
  2. BC
  3. CRP
  4. Urine
  5. CXR if signs
  6. Stool culture if diarrhoea
    7 LP if < 1month or unwell or high/low WCC
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30
Q

Which children presenting with a fever should have an LP? (3)

A
  1. < 1 month
  2. 1-3 months and unwell
  3. 1-3 months and either raised or low WCC
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31
Q

In children > 3 months and 1 or more red feature what should be performed (4) and what should be considered (4)

A
  1. FBC
  2. BC
  3. CRP
  4. Urine
  5. CXR regardless of WCC and temp
  6. LP
    7.U+E
  7. Blood gas
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32
Q

In children > 3 months with 1 or more amber feature what investigation should they have (4) and what should be considered (2) ?

A
  1. Urine
  2. FBC
  3. CRP
  4. BC
  5. Consider LP
  6. CXR if fever >39 and WCC >20

(difference between red is CXR needs another reason and no U+Es/VBG)

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33
Q

If a child > 3 months with a fever only has green features but no source what should be done? (2)

A
  1. Urine sample
  2. Assess for signs of pneumonia
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34
Q

What is an amber flag for paeds re: skin colour

A

Pallor reports by parents

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35
Q

What are red flags for paeds re: skin colour? (3)

A
  1. Pale
  2. Mottled
  3. Blue
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36
Q

What are amber flags for paeds re: activity? (4)

A

1, Not responding normally to social cues
2. No smile
3. Only wakes on prolonged stimulation
4. Decreased acitivity

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37
Q

What are red flags for paeds re: activity (4)

A
  1. No response to social cues
  2. Appears ill to healthcare professional
  3. Does not wake or stay awake
  4. Weak/high pitched/continous cry
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38
Q

What are amber flags in paed re: resp (4)

A
  1. Nasal flaring
  2. RR > 50 in 6-12 months
    RR > 40 > 12 months
  3. <95% SATs
  4. Crackles on chest
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39
Q

What are red flags in paeds re: resp (3)

A
  1. Grunting
  2. RR >60
  3. Mod-severe chest indrawing
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40
Q

What are amber flags in paeds re: CVS (4)

A
  1. HR
    >160bpm < 1year
    > 150bpm 1-2 years
    > 140bpm 2-5 years
  2. CRT > secs
  3. Poorer feeding
  4. Decreased UO
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41
Q

What are paeds red flags re: CVS? (1)

A

Increased skin turgor

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42
Q

What are the other paeds amber flags (5)

A
  1. 3-6 months and fever >39
  2. Fever 5 days or more
  3. Rigors
  4. Swelling of joint/limb
  5. NWB limb
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43
Q

What are the other paeds red flags? (7)

A
  1. <3 months and fever >38
  2. Non blanching rash
  3. Bulging fontanelle
  4. Neck stiffness
  5. Status epilepticus
  6. Focal neurology
  7. Focal seizures
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44
Q

What is the appropriate management of a child < 3 months with suspected UTI?

A

MC+S
Refer paeds

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45
Q

In 3 month- 3yrs which ? UTI should get abx based on urine dip?

A

Either leuc/nit +ve
Send MC+S as well

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46
Q

> 3 years old and urine dip shows +ve nit but -ve leuc
What is the tx?

A

Abx and MC+S

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47
Q

> 3 years old urine dip:
+ve leuc / -ve nit

How should they be managed?

A

No abx unless good clinical evidence of UTI
Send MC+S

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48
Q

Which UTIs in paeds should be referred to paeds? (3)

A
  1. Unwell
  2. < 3 months
  3. Over 3 months but upper UTI
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49
Q

Which children should have an US in the acute phase of their UTI?

A
  1. Atypical (septic, no response abx, non E.coli)
  2. Recurrent if < 6 months old (reccurent = 3 lower UTI, or 2 if one was upper UTI)
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50
Q

Which children should have an US <6 weeks after their UTI? (2)

A
  1. All under 6 months
  2. > 6 month old but recurrent (3 lower UTIs or 2 if one is upper UTI)
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51
Q

Which organisms cause pneumonia in neonates? (5)

A
  1. E.coli
  2. B haemolytic strep
  3. Listeria
  4. Chlamydia
  5. CMV
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52
Q

Which organisms cause pneumonia in infants/toddlers? (5)

A
  1. RSV
  2. Parainfluenza
  3. S. pneumoniae
  4. H. influenza
  5. Mycoplasma
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53
Q

Which organisms cause pneumonia in older children and which is the most common? (3)

A
  1. Step pneumoniae (>common)
  2. H. influenza
  3. Mycoplasma
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54
Q

What do children with Mycoplasma pneumonia typically present like? (4)

A

Headache
Abdominal pain
Joint pain
Maculopapular rash

55
Q

Would does BTS recommend re: management of CAP and:
1. NGT
2. IVI
3. Chest physio

A
  1. Try and avoid NGT, if needed then smallest possible
  2. Daily U+Es if on IVI
  3. No role for chest physio
56
Q

What is first line for CAP in children?

A

Amoxicillin

57
Q

What antibiotic should be added if CAP in children not responding to abx or severe?

A

A macrolide

58
Q

What antibiotic should be used in influenza associated CAP in children?

A

Co-amoxiclav

59
Q

When should IV abx be used in management of CAP in children?

A

If unable to take orally
Even severe should be treated to PO if can take orally

60
Q

How long should children with severe CAP of empyema be followed up for?

A

Until normal CXR

61
Q

What age group is normally affect by Kawasakis disease?

A

< 5 years

62
Q

What are the features of Kawasaki disease? (8)

A
  1. Erythematous rash (early, may have resolved by presentation)
  2. Desquamousation palms/soles (late sign)
  3. Conjunctivitis/uveitis with no exudate
  4. Fissured lips
  5. Strawberry tongue
  6. Arthritis
  7. Unilateral cervical lymphadenopathy
  8. Raised inflam markers
63
Q

What is the treatment for Kawasaki disease? (2)

A
  1. Aspirin
  2. IV immunoglobulin
64
Q

What can Kawasaki disease lead to?

A

Coronary artery aneurysm

65
Q

What is dermatitis herpatiformis? (3)

A

Skin manifestation of coeliac
Itchy ++
Vesicles/papules knees/elbows/buttocks

66
Q

What is the treatment for dermatitis herpatiformis?

A

Dapsone

67
Q

What does erythema multiforme look like? (2)

A

Target lesions with pale centre
Usually extensor surfaces

68
Q

What are the causes of erythema multiforme? (3 infective, 2 drugs)

A
  1. Herpes
  2. Mycoplasma
  3. TB
  4. Sulphanamides (all begin with sulf-)
  5. Barbiturates
69
Q

How does erythema nodosum present? (4)

A
  1. Painful red nodules anterior surface both shins
  2. Fever
  3. Lethargy
  4. Arthralgia
70
Q

Give 5 causes of erythema nodosum?

A
  1. Strep
  2. TB
  3. Sulphonamides (sulf-)
  4. UC
  5. Sarcoid
71
Q

What is erythema marginatum?

A

Transient rash with raised edges in 20% causes of rheumatic fever

72
Q

What is erythema chronicum migrans?

A

Lyme disease
Begins red papules then spreads to produce erythematous lesions with pale centres and bright edges

73
Q

What is the treatment for uncomplicated Lyme disease in patients > 9 years?

A

Doxycycline PO

74
Q

What is treatment for uncomplicated Lyme disease in children < 9 years?

A

PO amoxicillin

75
Q

What is the treatment for Lyme disease in patients with CNS involvement or myocarditis with haemodynamic compromise?

A

IV ceftriaxone

76
Q

What organism is generally responsible for croup?

A

Parainfluenza

77
Q

What are the 5 parts of the Westley croup score?

A
  1. Stridor
  2. Retractions
  3. Air entry
  4. SATs <92%
  5. Reduced GCS`
78
Q

Describe the Westley croup score

A
79
Q

Give 3 features of diptheria?

A
  1. Exotoxin
  2. ‘Bull neck’
  3. Adherent exudate
80
Q

What is the treatment for diptheria?

A

IV erythromycin
Anti-toxin

81
Q

What is the management of acute epiglotitis? (3)

A
  1. Call anaesthetics and calm child
  2. Neb adrenaline (0.5ml/kg 1:1000, max 5ml)
  3. IV cefotaxime with I+V (gas induction)
82
Q

How will acute epiglotitis present differently to croup? (3)

A
  1. Less stridor
  2. Quicker onset
    3 More unwell
83
Q

What are the criteria for diagnosis of paeds DKA? (3)

A
  1. Gluc > 11 (can be normal)
  2. Acidosis - PH <7.3 of HCO3 <15
  3. Blood ketones > 3mmol/l
84
Q

What is the management of paed DKA who is alert, not vomiting and not dehydrated?

A
  1. sc insulin
  2. PO fluids
85
Q

What is the dose of insulin to be given in paeds DKA?

A

0.05-0.1 IU/mg/kg

86
Q

When should insulin be started in paeds DKA?

A

After at least 1 hour of fluids

87
Q

Over what period should IV maintenance be calculated in paeds DKA and why?

A
  1. 48 hours
  2. Avoid cerebral oedema
88
Q

What should be given in paeds DKA in the case of cerebral oedema and at what dose?

A

20% mannitol 0.5-1.0g/kg over 15 mins

or

5ml/kg hypertonic saline

89
Q

What is the pathophysiology of Henoch-Schonlen Purpura?

A

Vasculitis affected the skin/kidneys and GI tract

90
Q

What age groups does HSP affect?

A

4-11 years

91
Q

What does HSP rash looks like? (2)

A
  1. Erythematous macules becoming palpable purpuric lesions
  2. Buttocks and extensor surfaces usually
92
Q

What are the symptoms of HSP (4)

A
  1. Rash
  2. Abdo pain
  3. Arthralgia
  4. Testicular pain
93
Q

What can HSP lead to?

A

Nephritis can lead to renal failure

94
Q

What investigations should be carried out in HSP? (4)

A
  1. FBC
  2. U+E
  3. Urine dip
  4. BP
95
Q

What is the mechanism leading to ITP?

A

Autoimmune ?viral trigger

96
Q

How is ITP managed?

A

Conservatively
Platelets if bleeding

97
Q

What features point to a diagnosis of ALL in paeds purpura? (4)

A
  1. Heptato-splenomegaly
  2. Lymphocytosis
  3. Blast cells on blood film
  4. Low platelets
98
Q

What are appropriate sedative agents for painless procedures in paeds? (2)

A
  1. Chloral hydrate
  2. Midazolam
99
Q

What sedative agents are appropriate for minimal to moderately painful procedures in children? (2)

A
  1. Entonox
  2. Midazolam
100
Q

What sedative agents are useful for painful procedures in children? (3)

A
  1. Ketamine
    2 IV midazolam + fentanyl
101
Q

What monitoring is mandatory for min-mod paeds sedation?

A
  1. RR
  2. Pulse oximetry
102
Q

What monitoring is mandatory for deep sedation in paeds?

A
  1. 3 lead ECG
  2. ETCO2
  3. 5 mins BP
103
Q

What is the issue with using chloral hydate/ propofol and sevoflorane for paeds sedation?

A

No marketing authorisation for paeds

104
Q

When should we be cautious using midazolam in paeds?

A

< 6 months as has no marketing authorisation

105
Q

When is chicken pox infective?

A

48 hours before rash (most infective) until crusting (usually 5 days after rash commences)

106
Q

If a child has a petechial rash and a fever but none of the high risk clinical manifestations, what should trigger IV abx?

A

Raised WCC or CRP

107
Q

What is the strongest determining feature of Kawasakis?

A

Fever >38 degrees for > 5 days

108
Q

What is the earliest and what is the latest sign of Kawasakis?

A
  1. Rash - may have resolved be time of presentaiton and usually in first 5 days
  2. Desquamation
109
Q

What are the most common causative organisms causing meningitis in neonates? (4)

A
  1. Strep agalactiae (group B)
  2. E. coli
  3. Strep pneumonia
  4. Listeria
110
Q

What are the most common causative organisms in meningitis in children > 3 months

A
  1. Neisseria meningitidis
  2. Strep pneumonia
  3. H. influenza
111
Q

When is parvovirus infective?

A

10 days pre-rash until rash develops

112
Q

What are two concerns with regards to parvovirus?

A

1, Can trigger transient aplastic crisis in patients with sickle cell/heriditary spherocytosis etc.
2. Pregnant women can pass it on to fetus leading to complications inc fetal death.

113
Q

What are 5 ‘red flags’ for patients presenting with eating disorders?

A
  1. HR < 40bpm
  2. syncope
  3. postural drop
  4. high levels of dysfunctional exercise
  5. possible daily episodes of purging behaviours)
114
Q

Under what age should all limping children be investigated?

A

Under 3 years

115
Q

What are the criteria for conservative management of a limping child? (4)

A
  1. 3–9 years
  2. Afebrile
  3. Mobile
  4. Symptoms for less than 72 hours, or more than 72 hours and improving
116
Q

Hows should patients with a ‘red flag’ from the Medical Emergency in Eating Disorders framework (MEED) be managed?

A

Admission

117
Q

What causes ‘slap cheek’ rash?

A

Parvovirus B19

118
Q

What virus causes ‘hand, foot and mouth’?

A

Cocksackie A16

119
Q

What organism causes Scarlet Fever?

A

Step pyogenes

120
Q

What is the clinical course of scarlet fever?

A
  1. Sandpaper rash after 12-48hours on chest/stomach first, then flexor surfaces.
  2. After one week can develop desquamation of fingers/toes
  3. Strawberry tongue can occur
121
Q

What is the criteria for diagnosing nephrotic syndrome in children? (3)

A
  1. Oedema
  2. 3+ protein urine
  3. Albumin < 25

Need all 3

122
Q

What criteria are needed to diagnose Pertussis?

A

2 weeks of cough and at least one of the following:
- inspiratory whooping
- coughing paroxysm or fits
- apnea with or without cyanosis in infants
- Post-tussive vomiting without any obvious cause

123
Q

When is Hib vaccine given?

A

2 months, 3 months, 4 months (as part of 6 in 1)
and 1 year

124
Q

What is in the 6 in 1 vaccine given a 2,3 and 4 months?

A
  1. Diptheria
  2. Tetanus
  3. Pertussis
  4. Hep B
  5. Polio
  6. Hib
125
Q

How is mild/moderate/severe DKA defined in paeds?

A
  1. Mild = PH 7.2-7.29 or HCO3 < 15
  2. Moderate = 7.1-7.19 or HC03 < 10
  3. Severe = PH < 7.1 or HC03 < 5
126
Q

How much fluid should be given in paeds DKA initially and over what time in:
1. No shock
2. Shock

A
  1. 10ml/kg over 1 hour
  2. 10ml/kg bolus up to maximum of 40ml/kg (above this call PICU)
127
Q

What is the formula for paeds fluid replacement in DKA?

A

Fluid replacement = fluid deficit + maintenance fluids over 48 hour

128
Q

How do we calculate the fluid deficit in paeds DKA?

A

% dehydration x weight (kg) x 10

Minus the 10ml/kg initial bolus if no shock, if shock present do not subtract

e.g. 12 kg child not shocked
= 7 x 12 x 10
= 840ml
- 12 x 10ml
= 720ml

129
Q

What is the paeds maintenance fluids calculations?

A
  1. 4ml/kg for first 10kg
  2. 2ml/kg for second 10kg
  3. 1ml/kg thereafter (max 80kg)
130
Q

What fluids should for replacement in paeds DKA?

A
  1. Isotonic saline
  2. Add potassium when PU’ing
  3. Once glucose < 14 mmol then switch to 5% dextrose
131
Q

What period should children with Pertussis be excluded from school?

A
  1. 48 hours from start of abx

or

  1. 21 days from onset of symptoms
132
Q

What abx should be used in Pertussis

A

Macrolides

133
Q

When should PHE be notified re: Pertussis ?

A

Within 3 days of it being suspected (do not need proven diagnosis)

FRCEM SBA (12 decks)

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