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Specialities > Paediatrics 2 > Flashcards

Paediatrics 2 Flashcards

1
Q

Name some specific types of epilepsy that can be diagnosed in a child:

A

Childhood onset Absent seizures
~ 6 years old
- Sodium Valproate
- Ethosuximide

Lennox- Gastuat syndrome

  • multiple seizure types, usually atonic
  • cognitive impairment
  • Slow spike wave on EEG

Juvenile myoclonic epilepsy
- muscle twitches/ contractions/ jumps

West’s syndrome/ Infantile spasms:
~4-6 months
- Extension of trunk and extension of arms
- usually underlying neurological condition
- poor prognosis
- predinislone is 1st line

Dravet syndrome

  • severe myoclonic epilepsy
  • resistant to drugs
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2
Q

What are the different types of cerebral palsy seen?

A

Spastic hypertonia
- motor cortex

Dyskinetic (basal ganglia)

  • Athenoid (hyper movement, grimace, drooling)
  • Dystonic

Ataxic
- cerebellum

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3
Q

What are some gait changes seen with cerebral palsy?

A

Circumductive gait
- seen with spastic hemiplegia

Scissoring
- spastic diplegia

Ataxic gait

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4
Q

What are some causes of cerebral palsy?

A

Antenatal:

  • Maternal infection (rubella, toxoplasmosis)
  • intrauterine injury
  • maternal disease (hypothyroidism)

Perinatal:

  • birth asphyxia
  • pre-term

Post-natal:

  • meningitis
  • severe neonatal jaundice
  • heady injury
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5
Q

What prostaglandin drug can be given to maintain the ductus arterioles?

A

Alprostadil

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6
Q

How is vesicoureteral reflux diagnosed and how is scarring assessed?

A

Micturating Cystourethrogram
- diagnosis

DMSA Scan
- for evidence of scaring

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7
Q

If a neonate goes into cardio-respiratory arrest and on auscultation you can hear tingling in the chest, what is the most likely diagnosis?

A

Diaphragmatic hernia
- leading to bowel within the thoracic cavity which affects lung maturity

Intubation is needed as the baby can fail quickly after birth

Causes pulmonary aplasia

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8
Q

What is your emergency treatment of croup?

A

High flow oxygen
Nebulised adrenaline
IV dexamethasone

*used for severe croup

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9
Q

What are some features of cystic fibrosis in the new born and later life?

A

Meconium ileus
Recurrent chest infections
Malabsorption
Nasal polyps

Later life:

  • short stature
  • delayed puberty onset
  • male infertility
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10
Q

What are some features in children with cystic fibrosis (usually in those who were missed at birth)

A

Short stature
Reduced growth (drop in centiles)
Diabetes
Nasal polyps

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11
Q

What are the serious complications of measles?

A

Acute otitis media
Pneumonia
Encephalitis

  • Subacute sclerosing panencephalitis
  • appears some 5-10 years after infection due to reactivation and inappropriate immune response
  • behaviour changes / personality changes
  • memory changes
  • Seizures
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12
Q

What investigations would be warranted into suspected biliary atresia?

A

Bilirubin

  • conjugated
  • unconjugated

LFTs

Sweat tests (check for cystic fibrosis)

Alpha -1 antitrypsin

Biopsy**
Ultrasound**
HIDA scan**

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13
Q

What testing is done at birth to assess for hearing loss, and what is the follow on test if abnormal?

A

Otoacoustic emission test
- small click generated which then creates an echo if the cochlear is normal

Auditory brainstem response
- done next if Otoacoustic emission test is abnormal

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14
Q

What is the formula for blood resuscitation in paediatrics?

A

Change in Hb (g) x Weight (kg) x 4

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15
Q

How is pyloric stenosis diagnosed and what will be seen? and what is the mangement?

A

Diagnosed via ultrasound
- thickened pyloric muscle

Correct Electrolyte imbalance
NG tube
Ramstedt pyloromyotomy

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16
Q

List some causes of bilious vomiting in a child:

A 
Intestinal atresia 
Necrotizing enterocolitis 
Hirschsprung disease 
Intussusception 
Malrotation volvulus 
Meconium plug
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17
Q

What are the signs and symptoms of NEC and how is it investigated and treated?

A 
Stable preterm who goes off feeding 
Abdominal distention 
Bloody stools 
Bilious vomit/ aspirates 
Pyrexia 
Haemodynamically unstable

Investigations:

  • FBC **platelets reflect severity
  • Cultures
  • CRP
  • ABG
  • Culture stool
  • Abdominal x-ray
  • left lateral decubitus

Management:

  • Stop feeds and insert TPN
  • IV fluids
  • Antibiotics IV broad spectrum
  • NG tube - for aspirates

Surgical:
needed for stage III onwards
- bowel resection
- stoma formation

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18
Q

How does malrotation of the gut present and what is the diagnostic procedure?

A

Due to failure of intestinal rotation typically affected the duodenal-jejunal flexure which comes to lie on the right instead of the left of the midline.

Presentation:

  • Bilious vomiting
  • abdominal distention
  • blood per rectum (late sign due to gut ischemia)
  • Metabolic acidosis

Diagnosed:
- G.I contrast study

Treatment:

  • IV fluids
  • NG drainage
  • IV broad spectrum antibiotics
  • Emergancy laparotomy *surgical Emergancy
  • if necrotic gut it removed and stoma
  • if entire midgut is affected palliative care
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19
Q

What condition is intestinal atresia highly associatted with and what sign is seen on x-ray?

A

Down’s syndrome

Double bubble

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20
Q

What condition is a meconium plug associated with and how is it diagnosed and treated?

A

Cystic fibrosis
- 5-10& will have CF

Features:

  • obstruction
  • bilious vomit

Diagnosed:
- Gastrografin

Treatment:

  • Bowel rest
  • IV fluids
  • NG tube decompression
  • Antibiotics
  • Gastrografin - breaks up material

if medical failure then:
- lapartomy +/- ileostomy

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21
Q

When approaching a Surgical abdomen what investigations should be done in what order?

A 
History 
Examination 
Urine Beta hCG 
Blood tests 
Repeat examination 
Ultrasound
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22
Q

In a female child patient presenting with abdominal pain what must one make sure to ask:

A

Have they started menarche

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23
Q

What are the signs and symptoms of intussusception:

A

*most common place is the ileocaecal valve, usually due to enlarged Peyer Patches following viral infection (in older children there tends to be a history of HSP or lymphoma)

Abdominal pain
Pale and unwell
Redcurrent jelly stools
Floppy and hemodynamically unstable

Classic triad is:

  • abdominal pain
  • Bilious vomit
  • redcurrent jelly stools
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24
Q

What are the maximum hourly rates of fluids for children?

A

104ml/hr for males

83ml/hr for females

25
Q

What calculation can be done if the weight of a child is not available to work out how much fluids should be given?

A

(Age (years) +4) x 2

26
Q

What fluid should be used for resuscitation in paediatrics?

A

Normal saline 0.9%

- no additional electrolytes

27
Q

If a girls of 50kg requires maintanance fluids what is amount that should be given?

A

this would equate to 90ml/hour which is above the max dose, therefore answer is:
- 83ml/hour

28
Q

In a trauma patient how much fluid bolus should a child recieve?

A

10ml/kg

*10ml/kg for trauma.

if you do not have childs weight you need to age. then:
(Age +4) x 2

29
Q

When should inguinal hernias be fixed in a neonate/ infant:

A

Neonate: before discharge

Infant: next available list

*if there is an emergency they should be seen as such i.e. incarceration

30
Q

When is surgery indicated for a hydrocele.

A

If not closed by age 3

*90% close by 1 year old

31
Q

Name some situations which may suggest non-accidental injury:

A

Discrepancy between the history and degree of injury

Prolonged time between injury and seeking care

Repeats of injury

Inconsistent history between caregivers

History of “doctor hospital shopping”

When parents do not comply with medical advice

Area of injuries:

  • groin
  • face
  • metaphysis
  • multiple bruises of varying age
  • injury not consistent with age of child
32
Q

What types of injuries are suggestive of NAIs?

A

Injuries to the genital/ perianal area

Fractures of long bones <3 years old
- especially humorous

Skull and rib fractures <24 month year old

Metaphysis fractures

Well demarcated burns

Subdural haemorrhages

Retinal haemorrhages

Bruises of different colours
- multiple at different healing states

Injuries not consistent with age of child
- child with shin bruises but doesn’t walk

33
Q

What advice can be given out to help parents with a child after a concussion?

A

After concussion - Return to normality

- ACoRN

34
Q

Which ribs in children are least likely to get fractured? and if they are what does this suggest?

A

1st ribs.

if these are fractured then it is very likely there are much more severe injuries present

35
Q

If you suspect NAI in a child what is the most important action you should take?

A

Inform the most senior person on shift
Admit the child
Safe guard for other children

36
Q

What is the most common benign cause of inspiratory stridor in an infant?

A

Laryngomalacia
- congenitally soft larynx which leads to partial collapse during inspiration

usually self resolves by age 2

37
Q

How is whooping cough treated?

A

Macrolides (if within the 1st 21 days)
+
Notify public health

38
Q

What is the history and investigations into whooping cough?

A

History:

  • severe coughing that causes child to turn red in face and flail arms
  • Inspiratory whoop

Diagnosis:

  • FBC - lymphocytosis
  • Peri-nasal swabs - diagnostic
  • CXR - atelectasis
39
Q

What are the first set of vaccines given and when?

A

2 months:

  • DTaP
  • IPV
  • Hib
  • HepB
  • MenB
  • PCV
  • Rotavirus
40
Q

When is the MMR vaccine given?

A

12 months
and
3 years 4 months

41
Q

What type of test should be done of a LP sample for S.Pneumonia and Meningococcus?

A

PCR testing

42
Q

When is chicken pox no longer contagious?

A

After all the lesions have crusted over - usually 5 days after rash starts

43
Q

What is the schedule regime for immunisations for 12- 18 year olds:

A

DTaP
PCV
MMR

HPV

Men ACWY

44
Q

What is the initial management of Hirschsprung disease before surgical input?

A

Bowel irragation

45
Q

What is the management of a child with mild and severe croup?

A

Mild

  • Dexamethasone - PO
  • Supportive

Severe:

  • Nebulised adrenaline
  • Oxygen
  • Dexamethasone - IV
46
Q

At what age do you start steroids in suspected meningitis? and what antibiotics should be given?

A

> 3 months old

Antibiotics only:

  • ceftriaxone
  • amoxicillin
  • for listeria cover as well
47
Q

If a child is diagnosed with threadworms what is the medication that should be used and who should be treated?

A

Mebendazole

*the whole family needs to be treated

48
Q

Lymphadenopathy is very common in children and usually benign, list the features which are suggestive of malignancy and list some differentials:

A

Features:

  • Supraclavicular site
  • Epitrochlear site
  • Systemic symptoms
  • Hepatosplenomegaly
  • Signs of bone marrow failure

Differential malignancies:

  • leukaemia (ALL)
  • Lymphoma (Hodgkins, Burkits)
  • Neuroblastoma
  • Rhabdomyosarcoma
49
Q

What are the fluid resuscitations volumes used in paediatrics:

A

20ml/kg

10ml//kg used when:

  • haemorrhagic shock
  • cardiogenic shock
  • DKA
  • Neonate
  • Trauma

**if a child is requiring >2 boluses then ICU should be contacted.

50
Q

What is the algorithm for paediatric life support? 1 - puberty:

A

Get help
Assess airway and open
Look, feel, listen

5 rescue breathes

Check for ciruclation

15:2 ratio compression

51
Q

What diet advice would you give to CF?

A

High calorie + high fat + pancreatic supplements

52
Q

What diagnostic tests should be done into kawasaki disease? and what is the management:

A

There is no definitive test:

Bloods:

  • FBC - raised plts
  • CRP - raised
  • ESR - raised
  • LFTs - raised ALT

ECG
- looking for conduction defects pericarditis signs

Echocardiogram
- coronary artery aneurysm

Management:

  • IV immunoglobulin
  • Aspirin
  • Serial echocardiograms
53
Q

Following a diagnosis of diabetes type I in a child, what is likely to occur regarding their insulin regimen in the first 3-6 weeks?

A

The regime is likely to be lower than usual because there is a honeymoon period.

Typically a child needs 1unit/kg/ day but in the first 3-6 weeks this can be as low as 0.5units/kg/day

54
Q

What is the phenomenon called when children wake up with hyperglycaemia and why is this?

What is it called when they wake up with hypoglycaemia?

A

Dawn Phenomenon
- due to growth hormone and sex hormone released during growth

Somogyi phenomenon
- hypoglycaemia in the morning

55
Q

What tests are important to conduct in a female who is primary ammenoreachic?

A

FSH, LH

TFTs

Karyotyping

  • Turner’s syndrome
  • Androgen insensitivity (XY chromosome) - but lack the androgen sensitivity
56
Q

In a neonate with poor feeding, what are the main differentials to consider?

A

Infection

Sepsis

Congenital heart disease

Bronchiolitis

57
Q

What would you expect to see on the biochemical results for congenital adrenal hyperplasia? and what test is conducted to establish the cause?

A

Hyponatremia

Hyperkalemia

Acidosis

*they will also be tachycardia and underfilled

Hyperpigmentation may also be seen, especially of testes due to excessive ACTH release

Test:
17 - hydroxyprogesterone
- precursor to 21-alpha hydroxylase which doesn’t come about

58
Q

What is the assessment score used to assess croup?

A

Modified Westley Clinical Scoring System

  • stridor
  • intercostal recession
  • Air entry
  • Cyanosis
  • Level of consciousness
59
Q

Outline the differences between cephalohematoma and caput succedaneum:

A

Cephahaematoma forms later and is between the bone and periosteum and thus does not cross the periosteal/ suture lines.

caput succedaneum forms immediately after birth and is above the periosteum and this can cross the suture lines.

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