Paediatrics Flashcards
Name 3 advantages of breastfeeding for child and 3 for the mother
child - less infection, less allergies, increased IA, decreased SIDS, decreased GORD, decreased hernia
Mother - less postpartum haemorrhages and increased weight loss, less osteoporosis, delays fertility
What are the types/direction of squints?
manifest = -tropia latent = -phoria eso- = convergent exo- = divergent hyper- hypo- e.g. esophoria
What is the difference between manifest and latent stabismus?
manifest - abnormal alignment of eyes present all the time
latent - eyes straight when open but deviated when covered
How would you calculate maintainence fluids?
first 10kg = 100mls/kg
second 10kg = 50 mls/kg
rest = 20 mls/kg
What is a bolus of fluids?
20 mls/kg of 0.9% NaCl
How do you calculate deficit fluids?
deficit (%) x 10 x kg
How do you do paediatric resuscitation?
15 compression - 2 breaths
What are the 6 aspects of sepsis intervention?
BUFALO Blood culture, screen, U&E Urine output/hr Fluid resus Antibiotics IV Lactate O2
What is a risk for neonatal feeds?
Too much, too quickly can cause necrotising enterocolitis
Which antibiotics would you give for neonatal sepsis?
Benzylpenicillin
Gentamicin
Name 4 risk factors of neonatal sepsis
PROM
pre-term
maternal pyrexia
group B strep
What is a red flag in a squint?
Always scan paralytic squints
The eye won’t move
due to nerve palsies, muscle/structural problems
Name 5 things involved in a septic screen
FBC, ESR, CRP, blood culture, urinalysis and urine culture, XR - chest, abdo, pelvis, LFT, LP
What are 3 contraindications for LP?
raised ICP, abnomal neurological signs, GCS <8, infection of site, unstable, clotting disorder
Where would you peform an LP?
L3-L5
What are the two major risks of an LP?
infection, bleeding can cause a clot which could lead to nerve damage or paralysis
What are three tests for intracranial pressure?
fundoscopy, fontanelles, HR (will be low in raised ICP), BP (will be raised)
What in CSF will indicated bacterial infection?
raised polymorphs (WBC) raised protein low glucose
What in CSF indicates viral infection?
raised lymphocytes
raised or normal protein
normal or low glucose
What in CSF indicates TB?
raised lymphocytes
very high protein
low glucose
What are 4 milestones of a 6 week old?
- good head control - can raise head to 45o on tummy
- Tracks
- startles/stills at loud noises
- social smile
What are the 4 categories of development?
gross motor, fine motor/vision, speech/language, social
What are 4 milestones of a 6 month old?
- sits without support, rolls tummy to back
- palmar grasp, transfers hand to hand
- babbles, understands bye-bye
- puts object to mouth, shakes rattle
What are 4 milestones of a 1 year old?
- Walks unaided
- scribbles side to side, neat pincer grip, feed themselves
- starting to speak - 3 words
- waves bye, hand clapping
What are 4 milestones of an 18 month old?
- runs, jumps
- can stack 4 blocks
- shows the understanding of nouns
- imitates everyday activites
What are 4 milestones of a 2 year old?
- can go up and down stairs
- can stack 8 blocks
- shows the understanding of verbs, 2 words joined together
- eats well with a spoon
What are 4 milestones of a 3 year old?
- 3 hops, up stairs 1 foot, down stairs 2 feet
- turns one page of a book at a time
- understands negatives, speech understandable
- can put a tshirt on, plays alone, bowel control
what are 4 milestones of a 4 year old?
- walks up and down stairs in an adult manner
- can draw cross
- understands complex instructions, count to 5
- can dress, has best friend
What are 4 milestones of a 5 year old?
- rides a bike
- can draw a triangle or a person
- knows name, address and DOB
- engages in imaginative play
At what age is lack of walking and talking concerning?
2 years old
What is the definition of cerebral palsy and what are the 3 main types?
an umbrella term encompassing a wide spectrum of physical/mental impairment
spastic, dyskinetic, ataxia
What tests would you do if you suspect cerebral palsy?
genetic, metabolic, infection, imaging, neurophysiology, histopathology, hearing, vision
How would you treat cerebral palsy?
MDT, botox helps spasticity (wears off in 3-6 months)
What would show up on an EEG of absence seizures?
3hz spike and wave
How would you treat absence seizures?
ethosuximide
What are the symptoms and treatment of juvenile myoclonic epilepsy
morning symptoms e.g. clumsiness like spilling cereal
sleep deprivation brings on seizures
Treat - keppra, valporate, lamotrigene
What does choas on an EEG indicate?
infantile spasms
How would you treat neonatal sepsis?
What is the most likely organism?
benzylpenicillin, gentamicin
Most likely caused by group B strep
What counts as neonatal hypoglycaemia?
<2.5 mmol/L - lack of glycogen stores in neonates
What type of fluids would you give a child?
0.9% NaCl + 5% glucose + 10mmol KCl
What is normally a bolus of fluid for a child?
20 mls/kg 0.9% NaCl
When would you give a different type of fluid bolus and what is that bolus?
10 mls/kg 0.9% NaCl in trauma, DKA and neonates
What would you see in an ABG of respiratory acidosis?
Name 3 causes
pH < 7.35
CO2 > 6
- airway obstruction e.g. bronchiolitis, asthma
- inability to ventilate e.g. neuromuscular disorder GBS, ALS,
- depression of central respiratory centre due to drugs
What would you see in an ABG of metabolic acidosis?
Name 3 causes
pH < 7.35
HCO3 < 22
sepsis, DKA, drugs, alcohol, renal failure
What would you see in an ABG of respiratory alkalosis?
Name 3 causes
pH >7.45
pCO2 < 4.6
hyperventilation e.g. anxiety, stroke, meningitis, pregnancy
What would you see in an ABG of metabolic alkalosis?
Name 3 causes
pH >7.45
HCO3 > 44
vomiting, alkalosis, hypokalaemia, burns
What causes retinopathy of prematurity?
vessels grow in the back of the eye due to too much oxygen causing blindness
Treat with lasers
What is an intraventricular haemorrhage and what can it develop into?
Bleeding into brain’s ventricular system where CSF is produced
can develop into periventricular leukomalacia - which can cause spastic quadraplegic CP
What is the most common type of leukemia in children?
Acute lymphoblast leukemia - B and T lymphocytes abnormal
Acute > 20% blasts
What are the 4 types of leukemia?
ALL, CLL, acute myeloid leukemia AML, CML
What are the symptoms of leukemia?
anaemia, flu-like symptoms, bleeding, bruising, enlarged spleen, enlarged lymph nodes
What is the treatment of leukemia?
chemo, clinical trials, anti-microbes, BM transplant
How do you estimate the weight of a child?
(Age +4) x2
What are three symptoms of anaphylaxis?
uricaria, itching, angioedema, wheeze, stridor, SOB, tachycardia, abdominal pain, collapse, hypotension
How would you treat anaphylaxis?
ABCDE, o2, IV fluids, IM adrenaline, hydrocortisone IV, antihistamines
Measure tryptase
What is the Apgar scoring system?
Measure of fetal wellbeing Activity (muscle tone) Pulse (>100) Grimace (reflex irritability) Appearance (skin colour) Respiration 7-10 good, <3 very low
What are the TORCH neonatal infections?
Toxoplasmosis (CP, microcephaly)
Rubella (CP, glaucoma, deafness)
CMV cytomegaly virus (sensorinueral deafness, growth retardation, CP, jaundice)
Herpes simplex (limp hypoplasia) - give VZIG
What is VZIG?
varicella zoster immune globulin IgG
What is MAS?
Meconium aspiration syndrome
What treatment would you give a baby for group B strep?
benzylpenicillin and gentamicin
What is persistent pulmonary hypertension of newborn?
failure to transition from fetal circulation to adult circulation after birth
RF: MAS, RDS, sepsis, maternal NSAID in 3rd trimester, maternal SSRI use
What is one thing you could use to treat brain haemorrhage in newborns?
vitamin K
What promotes ductus arterosis closure in first 48 hours of birth?
cyclo-oxygenase inhibition
What are 3 causes of a non-blanching rash?
meningococcal septicaemia, ALL, congenital bleeding disorders, NAI, HSP (henoch-schonlein purpura)
What is HSP?
Henoch-Schonlein purpura
IgA mediated small vessel vasculitis
What is Kawasaki disease?
medium sized vessel vasculitis
MYHEART (mucosal involvement, hand and feet, eyes, adenopathy, rash, temp)
What is DIC?
disseminated intravascular coagulation - symptom of meningococcal septicaemia
What is on an LP of meningoccocal septicaemia?
low glucose, high protein, cloudy
How does rheumatic fever present?
usually 2-4 weeks after tonsolitis
hot, swollen, painful joints
pericarditis, myocarditis, endocarditis, murmurs, chorea
Treat - NSAIDs and long term antibiotics
What is chickenpox and how would you describe the rash?
varicella zoster virus
widespread, erythematous, raised, vesicular blistering lesions
What is the advice on how to treat nappy rash/thrush?
leave nappy off as much as possible and change often
use frangrance and alcohol free gel
pat dry
use barrier cream or ointment before new nappy - zinc and castor oil
hydrocoritisone
NOT TALCUM POWDER
What is impetigo and how would you treat it?
Staph aureus
golden crust around nose or mouth
Treat - topical fusidic acid, flucloxacillin
What is erythema infectiousum?
Slapped cheek
Parvovirus B19
- can spread to uper arms
risky for kids with sickle cell or thalassemia
What is seborrhoeic dermatitis?
cradle cap
What are common birth marks?
Salmon patch - fade
infantile haemangioma - raised strawberry mark, disappear by age 7
Capillary malformation (port wine stain) - permanent
Cafe-au-lait spots - over 5 = neurofibromatosis
Mongolian spots - usually disappear by 4
congenital melanocytic naevi - moles
What is erythema multiforme?
central target lesion - often caused by drugs, infection or idiopathic
What does severe combined immunodeficiency cause?
low B and T lymphocytes and immunoglobulins
How would you monitor and treat Kawasaki disease?
recurrent echocardiogram is vital- to show dilation and aneurysm of coronary arteries
Aspirin, IVIG
What is obstructive shock?
physical obstruction of great vessels of heart e.g. PE
What is distributive shock?
abnormal distribution of blood flow in smallest blood vessels that results in inadequate blood supply to body’s tissues and organs e.g. sepsis, anaphlylactic, neurogenic
What is the 24hr management priority after diagnosis of AML?
tumour lysis syndrome
What proteins are deficient in haemophilia?
factor VIII and IX
Name 3 differentials for non-blanching rash
Henoch-Schonlein Purpura
meningococcal septicaemia
capillary rupture due to increased pressure
What is a greenstick fracture?
one side of cortex buckled and one side broken
What are the normal ages of puberty?
Girls 10-14
Boys 12-16
What are normal testicular volumes?
about 4mL volume at puberty, 12.5-14mL adult
measured by orchidometer
