Paediatrics Flashcards
Categorise paediatric limp according to age.
ANY AGE
- Septic arthritis
- Cellulitis
- Osteomyelitis
- Trauma
- Haemarthrosis
- Neoplasia
AGE 1 - 3
- DDH
- Transient synovitis
- Toddler’s fracture
- Rickets
AGE 3- 10
- Transient synovitis
- Rickets
- Perthe’s
- Leg length discrepancy
AGE 10 - 16
- SUFE
- Osgood Schlatter
- Frieberg disease
- Chondromalasia
List the risk factors for developing bronchiolitis?
- Young infants (age under 3 months)
- Premature birth (born <35 weeks gestation) (infants born at <29 weeks of gestation are at a particularly higher risk for hospitalization from RSV infection)
- Chronic respiratory disease (including bronchopulmonary dysplasia)
- Congenital heart disease (particularly heamodynamically significant congenital heart disease, e.g. with pulmonary hypertension)
- Immunodeficiency
- Severe congenital or acquired neurologic disease (neuromuscular disorders)
List the criteria for hospital admission in patient with bronchiolitis?
- Apnoea (observed or reported)
- Persistent oxygen saturation of less than 92% when breathing air
- Inadequate oral fluid intake (50 - 75% of usual volume, taking account of risk factors
- Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of more than 70 breaths/minute.
- Consider risk factors for more severe bronchiolitis.
- Social issues consider factors that may affect a carer’s ability to look after a child with bronchiolitis, for example:
– Social circumstances
– The skill and confidence of the carer in looking after a child with bronchiolitis at home
– Confidence in being able to spot red flag symptoms
– Distance to healthcare in case of deterioration (NICE CKS, 2015).
What fracture patterns will suggest NAI?
- Rib fractures
- Femoral fractures in children who are not walking
- Metaphyseal fractures in very young children
- Spiral or oblique fracture
- Skull fracture
- Tibia & Fibula fracture in children under 18 months
What are the differential for croup?
- Acute epiglottitis
- Bacterial tracheitis
- Foreign body, inhaled or aspirated
- Allergic reaction / anaphylaxis
What are the components of westley croup score?
- Retraction
- Air entry
- Stridor
- SPO2 < 92%
- Level of consciousness
Contraindication for diamorphine intranasal administration
- Children < 10 kg
- Known allergy
- Head injury or neurological problem
- Epistaxis
- Airway compromise
Which circumstances in paediatric cardiac arrest would you administer Sodium bicarbonate 8.4% (1ml/kg)?
- Hyperkalaemia
- TCA overdose
- Prolonged arrest
When would you admit a child with febrile convulsions for paediatric assessment?
- It is the first presentation of febrile seizure (or a subsequent febrile seizure and the child has not had previous specialist assessment).
- The child is less than 18 months of age
- There is diagnostic uncertainty
- There are any features of a recurrent complex febrile seizure.
- There is any focal neurological deficit.
- There was a decreased level of consciousness prior to the seizure.
- The child has recently taken antibiotics (may mask the signs of central nervous system infection).
- There is parental/carer anxiety and/or difficulty coping.
What are the complications of retained foreign body aspiration?
- Complete airway obstruction
- Atelectasis
- Pneumonia
- Bronchiectasis
- Abscess
What are the 5 low risk features for BRUE?
- > 60 days
- Born >32 weeks
- First event
- Event lasted for < 1 minute
- No CPR by trained health care.
How would you clinically diagnose whooping cough?
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
What are the complications of whooping cough?
Serious complications of pertussis include:
- Apnoea.
- Pneumonia (usually caused by secondary bacterial infection).
- Seizures.
- Encephalopathy (rare in adults).
Less serious complications include:
- Otitis media in children (caused by secondary bacterial infection).
- Unilateral hearing loss (rarely reported).
- Increased intra-thoracic and intra-abdominal pressure due to violent and/or prolonged coughing can cause:
- Pneumothorax.
- Umbilical and inguinal hernias, and rectal prolapse.
- Rib fracture and herniation of lumbar intervertebral discs.
- Urinary incontinence.
- Subconjunctival or scleral haemorrhage, and facial and truncal petechiae.
- Frequent post-tussive vomiting can lead to severe dehydration and/or malnutrition.
When would you admit patient with whooping cough?
- 6 months of age or younger and acutely unwell.
- Has significant breathing difficulties (for example apnoea episodes, severe paroxysms, or cyanosis).
- Has a significant complication (for example seizures or pneumonia).
How would you differentiate between bacterial tracheitis acute epiglottitis?
Bacterial Tracheitis
- Rapid onset
- Fever > 39
- Productive cough
- Hoarse voice
- Partial or no response to Adrenaline nebs
- Steeple on Lateral neck xray
Epiglotittis
- Very rapid onset
- Fever > 39
- Suppressed cough
- Muffled voice (Dysphagia + Drooling)
- No response to Adrenaline
- Thumb printing sign on lateral neck X-ray
