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Emergency medicine > Paediatrics > Flashcards

Paediatrics Flashcards

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1
Q

When should lumbar puncture be delayed?

A
  1. Sepsis or rapidly spreading rash
  2. Respiratory/ cardiovascular compromise
  3. High risk of bleeding
  4. Sign of raised ICP
    - papilloedema
    - GCS <= 12
    - uncontrolled seizures
    - focal neurological deficits
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1
Q

Meningitis mx

A

< 3 months: cefotaxime + amoxicillin

3 months - 50 years: ceftriaxone ± Dexamethasone

> 50 years: ceftriaxone + amoxicillin

*notifiable disease

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2
Q

When to hold Dexa in meningitis?

A
  • septic shock
  • meningococcal septicaemia
  • immunocompromised
  • meningitis after surgery

**ideally should be given within 12 hours of starting abx

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3
Q

bacterial meningitis prophylaxis

A

contact within 7 days before rash onset - Oral ciprofloxacin or rifampicin

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4
Q

minimal change disease 1/3 rule

A

1/3 recovers
1/3 infrequent relapse
1/3 frequent relapse (stops before adulthood)

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5
Q

Intussusception

A
  • 6-36 months. more in boys
  • triggered by infection e.g. viral URTI, Rota, HSP
  • non-bilious vomiting -> bilious vomiting
  • intermittent abdo-pain (15 mins)
  • inconsolable crying, drawing knees
  • late: red currant jelly stool
  • o/e RUQ sausage mass

Ix US
Mx air enema unless perforated and peritonitis

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6
Q

Richter hernia

A

strangulation without obstruction

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7
Q

Congenital inguinal hernia

A

Patent processus vaginalis
More common in premature babies, on the right side

Mx urgent surgical repair, risk of incarceration

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8
Q

Infantile umbilical hernia

A

More common in premature and afro-Caribbean

Spontaneous resolution by 4-5

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9
Q

Hodgkin lymphoma - what age?

A

Bimodal
20s and 60s

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10
Q

Hodgkin lymphoma subtypes

A
  1. Nodular sclerosing
  2. Mixed cellularity
  3. Lymphocyte predominant
  4. Lymphocyte depleted
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11
Q

Hodgkin lymphoma poor prognostic factors

A

B symptoms:
Night sweats
Fever > 38ºC
Weight loss >10% in 6 months

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12
Q

Testicular torsion presentation

A
  • Severe scrotum pain, radiating to lower abdomen
  • N+V
    o/e:
  • testis is swollen, tender, and retracted upwards
  • cremasteric reflex lost
  • Prehn’s sign negative (elevation of testis doesn’t relieve pain)
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13
Q

Pyloric stenosis presentation and cause

A

2nd-4th weeks old
Projectile vomiting 30 mins after feeding
Palpable mass in upper abdomen

Hypertrophy of the circular muscles of pylorus

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14
Q

Testicular torsion mx

A

Urgent surgical exploration and fixation bilaterally
(Bell clapper deformity)

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15
Q

Pyloric stenosis risk factors

A
  1. Boys
  2. Family history
  3. First-borns
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16
Q

Pyloric stenosis Ix and Mx + complications

A

Abdominal US

Mx Ramstedt pyloromyotomy

Complications: Hypochloraemia, hypokalaemia and alkalosis

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17
Q

Acute epiglottitis

A

HiB, tripod and drooling

  • Call seniors, do not examine
  • Give O2, IV abx and steroids
  • Endotracheal intubation may be necessary
18
Q

Type 1 DM Ix

A
  • Test for ketones (urine dip or blood)
  • Random blood glucose
  • C peptide (low in T1DM)
  • autoantibodies

*c peptide and autoantibodies in atypical presentations

19
Q

Features of DKA

A
  • polyuria, polydipsia
  • NV, abdominal pain
  • Kussmaul respiration (deep hyperventilation)
  • Acetone breath (fruity, pear breath)
20
Q

Type 1 DM diagnostic criteria

A

Symptomatic: fasting glucose > 7mM or random glucose > 11.1mM (or after 75g OGTT)

Asymptomatic: above but on two occasions

21
Q

DKA diagnostic criteria

A

all 3
1. Random blood glucose > 11mM/ or known diabetic
2. Blood ketones >= 3mM or urine ketone 2+
3. Bicarbonate < 15 or pH < 7.3

22
Q

DKA mx

A
  1. Fluid replacement
  2. Insulin
  3. Potassium and cardiac monitoring
23
Q

Fluid replacement in DKA

A

isotonic saline (0.9% saline)
1L over 1 hr
1L over 2 hrs
1L over 2 hrs
1L over 4 hrs
1L over 4 hrs
1L over 6 hrs

24
Q

Insulin in DKA

A

0.1unit/kg/hr - rapid acting

If glucose < 14mM, add 10% dextrose at 125ml/hr

*may need long acting too

25
Q

Potassium in DKA

A

K+ can drop while giving insulin
add 20mM KCl in 500ml
*may need cardiac monitoring

*normal potassium: 3.5-5.3

26
Q

Down syndrome features

A
27
Q

Down syndrome cardiac complications

A
  1. Endocardial cushion disease (atrioventricular septal canal defect)
  2. VSD
  3. Tetralogy of fallot
28
Q

Down syndrome associated conditions

A
  • Hypothyroidism
  • Subfertility
  • learning difficulty
  • ALL
  • atlantoaxial instability
  • Alzheimer’s disease
  • repeated resp infections + glue ear
  • short stature
29
Q

Kawasaki disease fx

A

crash and burn
- Conjunctivitis
- rash (maculopapular)
- lymphadenopathy
- strawberry tongue
- hand and feet desquamation
high fever

30
Q

Kawasaki disease mx

A

high dose aspirin
IvIg
echocardiogram for coronary artery aneurysm

31
Q

UTI under 3 months

A

urgent paediatrics review

32
Q

When to do urinalysis in kids?

A
  • Sx of UTI
  • Unexplained fever >38º
  • other infection not responding to treatment
33
Q

upper UTI in >3 months

A

3 days abx
nitrofurantoin, cefalexin
*safety net that they’ll improve in 1-2 days if not seek help

34
Q

US post-UTI

A

under 6 months - US after 6 weeks
over 6 months - US only if atypical or recurrent UTI

35
Q

UTI prevention

A
  1. use the potty more often
  2. time potty sessions
  3. empty bladder completely
  4. drink water
  5. avoid constipation
  6. cotton underpants
  7. no soap or bubble bath
36
Q

Paracetamol overdose within 1 hr mx

A

activated charcoal

37
Q

Paracetamol overdose mx

A

IV acetylcysteine over 1 hr if
- plasma paracetamol concentration above treatment line
- staggered overdose
- 8-24 hrs after 150mg/kg overdose even if concentration unknown
- >24hrs with jaundice and sign of hepatotoxicity

38
Q

Acetylcysteine side effects

A

Anaphylactoid reaction (non-IgE mast cell release)
mx: stop and restart at lower rate

39
Q

Prognostic factors for paracetamol overdose

A
  • prothrombin time
  • arterial pH <7.3
  • encephalopathy
  • raised creatinine
40
Q

Croup age group

A

6 months - 6 years
autumn

41
Q

Croup virus

A

parainfluenza virus

42
Q

Croup mx

A

all get single dose PO dexamethasone

emergency: O2 and nebulised adrenaline

admit if - under 3 months, or moderate/ severe croup

43
Q
A

Emergency medicine (5 decks)

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