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4th Year > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Examples of obstruction which may lead to decompensated respiratory failure in children ?

A

Foreign body aspiration
Asthma
Croup

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2
Q

Examples of respiratory depression which may lead to decompensated respiratory failure in children ?

A

Convulsions
Poisoning
Raised ICP

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3
Q

How are paediatric oropharyngeal airways measured ?

A

Midpoint of incisor to angle of mandible

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4
Q

How are paediatric oropharyngeal airways measured ?

A

Lateral edge of nostril to Tragus of ear

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5
Q

Airway signs of anaphylaxis?

A

Stridor

Wheeze

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6
Q

Circulatory signs of anaphylaxis?

A

Hypotension

Tachycardia

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7
Q

Response to anaphylaxis in children

A
  • call anaesthetist to secure airway
  • remove allergen
  • high flow oxygen
  • adrenaline IM
  • IV hydrocortisone
  • salbutamol NEB
  • IV chlorphenamine (antihistamine)
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8
Q

Characteristic signs if epiglottitis (paediatrics)

A

Drooling
Quiet
Septic appearance

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9
Q

Response for epiglottitis emergency

A
  • DO NOT ENDANGER AIRWAY
  • call anaesthetist early
  • once secured and anaesthetised start broad spec antibiotics e.g. Amoxicillin or 3rd gen cephalosporins (ceftotaxime)
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10
Q

Observations in type 2 respiratory failure

A

paO2

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11
Q

Causes of type 1 respiratory failure in children?

A
  • pneumonia
  • pleural effusion
  • pneumothorax
  • pulmonary oedema
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12
Q

Causes of type 2 respiratory failure in children?

A
  • severe asthma with exhaustion
  • reduced consciousness
  • exhaustion
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13
Q

Normal heart rate in infants ?

A

110-160 Bpm

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14
Q

Normal heart rate in younger children ?

A

140-95 Bpm

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15
Q

Normal heart rate in older children ?

A

120-80 Bpm

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16
Q

At what age does paediatric heart rate reach same as in adults ?

A

12 years

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17
Q

Normal Systolic BP in infants ?

A

70-90 mmHg

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18
Q

Normal Systolic BP in young children ?

A

80-100 mmHg

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19
Q

Normal Systolic BP in older children ?

A

90-110 mmHg

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20
Q

3 main areas to survey in recognition of circulatory problems for pRRAPID

A
  • vitals e.g. HR, pulse Vol, BP
  • skin and mucous membrane perfusion
  • organ perfusion e.g. Mental status, urine output, effect on breathing
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21
Q

Define shock

A

Generalised state of tissue hypoperfusion leading to inadequate supply of nutrients I.e. Oxygen and glucose to the tissues

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22
Q

Name 5 types of shock?

A
  • hypovolaemic
  • distributive
  • cardiogenic
  • obstructive
  • neurogenic
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23
Q

How is distributive shock different to other types ?

A

Occurs despite normal output of the heart

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24
Q

When does hypovolaemic shock occur ?

A

When lose more than 20% blood volume e.g. Trauma

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25
Q

Pathology of distributive shock ?

A

Vessels less responsive to vasoconstrictive agents

Septic or anaphylactic shock

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26
Q

Mechanism of cardiogenic shock ?

A

Pump failure of the heart, deceased output = reduced end organ perfusion
E.g. PE, cardiac tamponade

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27
Q

When does neurogenic shock occur ?

A

Loss of vascular tone normally supported by sympathetic nervous system I.e. CNS disruption/ injury

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28
Q

How much given in fluid bolus to children?

A

20ml/kg

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29
Q

Outline sepsis 6 pathway for response to sepsis in children

A
  1. Oxygen
  2. IV/Access and take blood
  3. IV/IO antibiotics
  4. Fluid resus (20ml/kg) saline 0.9%
  5. Senior help
  6. Inotropic support e.g. Adrenaline or dopamine
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30
Q

In children what are the 2 main causes of decompensated respiratory failure ?

A

Obstruction and respiratory depression

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31
Q

Classic presentation of PROM

A

Popping sensation and watery discharge

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32
Q

At what week of gestation is surfactant produced?

A

33

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33
Q

What does PPROM stand for ?

A

Preterm prelabour rupture of membranes

34
Q

What percentage of pregnancies does PPROM occur in ?

A

2%

35
Q

Of suspected PROM what is done to make diagnosis ?

A
  • look for amniotic fluid leaking from cervix and pooling in vagina
  • pad checks
36
Q

What should be monitored in PROM/PPROM scenarios ?

A
  • foetal heart rate
  • maternal temperature
  • if maternal fever check bloods
37
Q

Risk factors for PROM?

A
  • smoking
  • previous preterm delivery
  • vaginal bleeding during pregnancy
  • associated With lower genital tract infections
38
Q

How is PPROM managed ? (<37 weeks)

A
  • Delay delivery using tocolytic agents for 48hrs if possible
  • antenatal steroids (lung maturation, decrease risk of IVH)
  • council parents
  • prepare for delivery
39
Q

How is PROM managed ? (>37 weeks)

A

Induce delivery if foetal distress or ascending infection

- monitor foetal HR and maternal temp

40
Q

What is the earliest sign of ascending infection in PROM?

A

Foetal tachycardia and slight elevation in maternal temperature

41
Q

3 most common causes of mortality in PPROM

A
  • immaturity
  • sepsis
  • pulmonary hypoplasia
42
Q

4 respiratory problems in low birthweight infants?

A
  • RDS (74%)
  • pneumothorax (5%)
  • apnoea/bradycardia/desaturations
  • bronchopulmonary dysplasia (chronic lung disease)
43
Q

Appearance of RDS on CXR ?

A

Ground glass appearance

44
Q

RDS is rare in full term babies, which group of full term babies are at increased risk ?

A

Those born to diabetic mothers

45
Q

How does RDS present ?

A
  • Cyanosis
  • tachypnoea > 60
  • increased work of breathing
  • expiratory grunt
  • present within 4hrs of birth
46
Q

How common is RDS ? (All births and prem)

A

1% all births

50% 26-28 weeks

47
Q

How is RDS treated ?

A
  • surfactant (curosurf) - get in before 1st breath
  • intubation
  • CPAP
  • antenatal glucocorticoids if prem anticipated
48
Q

Complications of RDS

A
  • pneumothorax
  • IVH
  • delayed cognitive development
49
Q

Management of hypotension in neonate ?

A
  • IV bolus of 10ml/kg 0.9% saline
  • inotropes e.g. Dopamine
  • hydrocortisone IV QDS (sometimes)
50
Q

How do IVH present in neo ages ?

A
  • apnoeas
  • reduced muscle tone
  • lethargy
  • seizures
  • abnormal eye movements
  • absent MOROS
51
Q

How are IVH managed in neonates

A

Support I.e. Correct anaemias, hypotension, Acidosis

  • ventilators support if deteriorate acutely
  • longterm management if seizures, neuro delay etc
  • limit handling keep baby calm
  • stabilise BP
52
Q

Outcomes of IVH in neonates ?

A
  • hydrocephalus
  • motor and cognitive deficits
    Neuro developmental delay
53
Q

Preventative measures for IVH in neonates ?

A
  • antenatal steroids

- avoid birth trauma

54
Q

Outline grading system for IVH in neonates

A

I - bleeding confined to germinal matrix
II - bleeding fills 10-50% ventricle
III - bleeding fills >50% ventricle
IV - bleeding into brain outside ventricles

55
Q

Signs of IVH in neonates

A
  • tense/bulging fontanelle
  • neuro depression -> coma
  • mild forms may have no signs or alternating symptomatic and asymptomatic periods
56
Q

Most common cause of heart murmur in newborns ?

A

Patent ductus arteriosus

57
Q

Where is the ductus arteriosus located ?

A

Connects pulmonary artery to proximal descending aorta just after left subclavian artery origin

58
Q

What percentage of circulation passes through the lungs in utero ?

A

10%

59
Q

Function of ductus arteriosus in utero?

A

Shunts blood away from unopened lungs

  • 12-18h after delivery closes (functionally) and blood is directed to opened lungs
  • anatomically closes after 2-3w
60
Q

Define persistent patency of ductus arteriosus

A

Remains open beyond

  • 3m in preterm babies
  • 1y in term babies
61
Q

Risk factors for patent ductus arteriosus

A
  • asphyxia during delivery
  • rubella infection during pregnancy
  • genetic syndromes e.g. Trisomy 21, holt-oram syndrome
62
Q

Presentation of ductus arteriosus in term baby

A
  • SOB
  • tachycardia
  • bounding pulses
  • continuous murmur
  • feeding problems
  • failure to thrive due to heart failure
  • if small PDA = asymptomatic
63
Q

What is likely cause if preterm baby with RDS does not improve after initial treatment or if improves and gets worse again and cannot be weaned off ventilator ?

A

Patent ductus arteriosus

64
Q

Presentation of ductus arteriosus in preterm baby

A

Many classic signs not present:

  • continuos murmur rarely heard
  • bounding peripheral pulses
  • hyperactive precordium
  • tachycardia with or without gallop
65
Q

What 3 conditions is Patent ductus arteriosus associated with ?

A
  • chronic lung disease
  • NEC
  • IVH
66
Q

Risk factors for NEC

A
  • prem
  • low birth weight
  • blood transfusion
  • PDA
  • abx > 10d
  • bottle fed
67
Q

Mortality rate in NEC

A

50%

68
Q

Presentation of NEC

A
  • feeding intolerance
  • classically preterm baby in first 2 weeks who showed initial progress in enteral feeds
  • bilious aspirates/vom
  • bloody stool
69
Q

Management of NEC

A
  • stop feeds to rest gut
  • IV Abx - amp/gent or cefotaxime + metronidazole or clindamycin
  • acute laparotomy
70
Q

Appearance of NEC on AXR?

A
  • intramural gas
  • bowel wall thickening
  • persistent bowel loops filled with gas
  • overall gaseous distension
71
Q

Define chronic lung disease in neonates

Aka bronchopulmonary dysplasia

A

Any baby with an oxygen requirement Beyond 28d if life

72
Q

What causes chronic lung disease (BPD) in infants ?

A
  • prem

- damaged caused by long term ventilation

73
Q

Management of infantile chronic lung disease/ bronchopulmonary dysplasia

A
  • continued ventilation with gradual weaning
  • steroids
  • nutrition
  • diuretics/caffeine?
  • immunisations
74
Q

What is retinopathy of prematurity ?

A

Eye disease affecting premature infants

  • abnormal proliferation of retinal blood vessels
  • scarring of retina and possible detachment
  • high oxygen is detrimental
75
Q

Who is screened for retinopathy of prematurity ?

A

Babies <1500g or those born <31w

- first assessment around 6w

76
Q

Treatment of retinopathy of prematurity ?

A

Laser ablation of the avascular retina

77
Q

Define neonate

A

A baby term or preterm up to 28days old

78
Q

Define term baby

A

Born between 37 and 42 weeks gestation

79
Q

What is the Barlow manoeuvre?

A

Physical exam performed on infants to screen for developmental dysplasia of the hip

  • adduct hip (towards midline) while applying light pressure on the knee, directing force posteriorly
  • if hip is dislocatable = positive test
80
Q

What is the Ortolani test?

A

Relocates hip dislocated during barlows

  • flex hips and knees of supine infant to 90 degrees
  • place anterior pressure on greater trochanter and abduct
  • positive sign = distinct ‘clunk’ as femoral head relocates
81
Q

What is the APGAR score ?

A 
Score done 1 and 5 mins after birth 
A - appearance (skin colour)
P - pulse (HR)
G - grimace (reflexes)
A - activity (tone)
R - respiration (RR and effort)

2 points available for each part, score of 8-10 at 5 mins = norm
* at 1 min most newborns cyanosed

82
Q

Average measurements of newborn ?

Head, length, weight

A
  • head = 35cm
  • length = ~ 50cm
  • weight = 2.5-3.5kg (5.5-7.7lbs)

4th Year (5 decks)

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