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ID study > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Signs of severe pneumonia in children (WHO guidelines)

A

Fever + Tachypnoea + 1 of the following:

  1. Severe respiratory distress
  2. Sats <90%
  3. Inability to eat/breastfeed
  4. Reduced LOC
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2
Q

Signs of severe dehydration (WHO guidelines)

A

2 or more of the following
1. Lethargy/unconsciousness
2. Sunken eyes
3. Unable to drink
4. Skin pinch very slow

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3
Q

Treatment of severe pneumonia in children

A
  1. Admit
  2. O2 if needed
  3. IV antibiotics (ampicillin + gent)
  4. Fluid balance
  5. Anti-pyretics
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4
Q

Treatment of severe dehydration in paediatrics

A
  1. IV/NG hydration (30ml/kg over 30 mins then 70ml/kg over 2.5 hours)
  2. Add in ORS orally when tolerates
  3. Admit
  4. Oral zinc
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5
Q

Common causes of diarrhoea in children

A
  1. Viral - rotavirus, norovirus, adenovirus, sapovirus, astrovirus
  2. Bacterial - E coli, salmonella, cholera, shigella, campylobacter
  3. Protozoal - Giadia, amoebiasis, crypto (HIV)
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6
Q

3 key assessments needed in diarrhoea management in children

A
  1. Malnourished?
  2. Shock?
  3. Dehydration?
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7
Q

Causes of pneumonia in children

A

Viral: RSV, influenza, parainfluenza
Bacterial: Strep pneumo, H influenzae, S aureus, mycoplasma

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8
Q

4 management points for ongoing management of diarrhoea in children

A
  1. Replace lost fluid and give extra for ongoing loses
  2. Feed early and extra
    (only with-hold food in initial fluid replacement phase)
  3. Zinc PO (though limited evidence)
  4. Advise when to return
    (worsening/fever/blood in stool/persistent diarrhoea)
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9
Q

Management of a child with severe acute malnutrition (10)

A

Early phase
1. Hypoglycaemia
2. Hypothermia
3. Dehydration
4. Electrolytes
5. Micronutrients
6. Initiate feeding
Later
7. Add in sensory stimulation
8. Increase to catch up feeding
9. Can add iron with micronutrients
10. Prepare for follow up

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10
Q

Package of care when starting ARVs in a young child

A
  1. Screen for TB and opportunitic infections
  2. Start ARVs according to guidelines
  3. Daily co-trimoxacole prophylaxis (all children <1 year and in order children with low CD4)
  4. Latent TB treatment
  5. Baseline bloods + CD4 count
  6. Support parents and family
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11
Q

Fever and positive malaria RDT within a few weeks of recent treatment.
1. What are the possibilities?
2. How do you investigate?
3. If it is current infection how do you manage?

A
  1. a) Reinfection b) Treatment failure c) Persistent antigen but no malaria
  2. Microscopy or LDH-based RDT
  3. <4 weeks from previous treatment failure, give 2nd line anti-malarials. >4 weeks treat as a new infection but consider different oral agent if available
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12
Q

What is the best clinical test to confirm cerebral
malaria?

A

Retinal fundoscopy:
1. Patchy retinal whitening
2. Focal changes of vessel colour
3. Retinal haemorrhages - often white
centred
+/- Papilloedema

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13
Q

Presumptive TB treatment “SHINE” trial treatment regime and indications

A
  1. Non-cavitory, non-miliary pulmonary TB in one lung lobe
  2. Peripheral LN TB
  3. Intra-thoracic LN TB
  4. Pleural effusion

Regime: 2 months HRZ(E),/ Isoniazid + rif + pyrazinamide +ethambutol 2 months HR

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14
Q

Meningitis B vaccination

A
  1. 6 serogroups A, B, C, W, X, Y with vaccination against ACWY conjugate vaccine from 2005
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15
Q

Neonatal tetanus clinical features and differentials

A
  • Fever
  • Breath holding
  • Difficulty opening mouth
  • Sensitive to light, sound, touch

Ddx
- Encephalitis
- Rabies
- Cerebral malaria
- Strychnine poisoning

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16
Q

Neonatal tetanus prevention and management

A
  • Clean delivery practice especially cord care
    -2 doses of tetanus toxois (1st dose ASAP in pregnancy and then 3 weeks pre delivery)
  • Minimise noise/light/sound
  • Source control
  • IV penicillin +/- metronidazole
  • Tetanus antitoxin
  • Sedative, antispasmodic, muscle relaxant
17
Q

Safest antibiotics to use in pregnancy

A

Penicillin, cephalosporins, erythromycin
Nitrofurantoin (avoid at term)
Clindamycin
Metronidazole (avoid at high dose)

18
Q

Antibiotics to absolutely avoid in pregnancy

A

Tetracyclines, streptomycin (ototoxicity)

19
Q

Malaria in pregnancy

A

Significant risks to the mother like anaemia and risks to foetus like spontaneous abortion, stillbirth, prematurity, low birth-weight
Treat with IV artesunate in severe malaria and ACT

20
Q

WHO Integrated Management of Childhood Illnesses (IMCI) initiative

A

Designed to support in rapidly assessing and providing treatment for common childhood conditions - particularly for children under 5 years old

ID study (23 decks)

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