Paediatrics Flashcards
1
Q
Name 3 advantages of breastfeeding for child and 3 for the mother
A
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
2
Q
What are the types/direction of squints?
A
manifest = -tropia latent = -phoria eso- = convergent exo- = divergent hyper- hypo- e.g. esophoria
3
Q
What is the difference between manifest and latent stabismus?
A
manifest - abnormal alignment of eyes present all the time
latent - eyes straight when open but deviated when covered
4
Q
How would you calculate maintainence fluids?
A
first 10kg = 100mls/kg
second 10kg = 50 mls/kg
rest = 20 mls/kg
5
Q
What is a bolus of fluids?
A
20 mls/kg of 0.9% NaCl
6
Q
How do you calculate deficit fluids?
A
deficit (%) x 10 x kg
7
Q
How do you do paediatric resuscitation?
A
15 compression - 2 breaths
8
Q
What are the 6 aspects of sepsis intervention?
A
BUFALO Blood culture, screen, U&E Urine output/hr Fluid resus Antibiotics IV Lactate O2
9
Q
What is a risk for neonatal feeds?
A
Too much, too quickly can cause necrotising enterocolitis
10
Q
Which antibiotics would you give for neonatal sepsis?
A
Benzylpenicillin
Gentamicin
11
Q
Name 4 risk factors of neonatal sepsis
A
PROM
pre-term
maternal pyrexia
group B strep
12
Q
What is a red flag in a squint?
A
Always scan paralytic squints
The eye won’t move
due to nerve palsies, muscle/structural problems
13
Q
Name 5 things involved in a septic screen
A
FBC, ESR, CRP, blood culture, urinalysis and urine culture, XR - chest, abdo, pelvis, LFT, LP
14
Q
What are 3 contraindications for LP?
A
raised ICP, abnomal neurological signs, GCS <8, infection of site, unstable, clotting disorder
15
Q
Where would you peform an LP?
A
L3-L5
16
Q
What are the two major risks of an LP?
A
infection, bleeding can cause a clot which could lead to nerve damage or paralysis
17
Q
What are three tests for intracranial pressure?
A
fundoscopy, fontanelles, HR (will be low in raised ICP), BP (will be raised)
18
Q
What in CSF will indicated bacterial infection?
A
raised polymorphs (WBC) raised protein low glucose
19
Q
What in CSF indicates viral infection?
A
raised lymphocytes
raised or normal protein
normal or low glucose
20
Q
What in CSF indicates TB?
A
raised lymphocytes
very high protein
low glucose
21
Q
What are 4 milestones of a 6 week old?
A
- good head control - can raise head to 45o on tummy
- Tracks
- startles/stills at loud noises
- social smile
22
Q
What are the 4 categories of development?
A
gross motor, fine motor/vision, speech/language, social
23
Q
What are 4 milestones of a 6 month old?
A
- sits without support, rolls tummy to back
- palmar grasp, transfers hand to hand
- babbles, understands bye-bye
- puts object to mouth, shakes rattle
24
Q
What are 4 milestones of a 1 year old?
A
- Walks unaided
- scribbles side to side, neat pincer grip, feed themselves
- starting to speak - 3 words
- waves bye, hand clapping
25
What are 4 milestones of an 18 month old?
* runs, jumps
* can stack 4 blocks
* shows the understanding of nouns
* imitates everyday activites
26
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
27
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
28
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
29
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
30
At what age is lack of walking and talking concerning?
2 years old
31
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
32
What tests would you do if you suspect cerebral palsy?
genetic, metabolic, infection, imaging, neurophysiology, histopathology, hearing, vision
33
How would you treat cerebral palsy?
MDT, botox helps spasticity (wears off in 3-6 months)
34
What would show up on an EEG of absence seizures?
3hz spike and wave
35
How would you treat absence seizures?
ethosuximide
36
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
37
What does choas on an EEG indicate?
infantile spasms
38
How would you treat neonatal sepsis?
| What is the most likely organism?
benzylpenicillin, gentamicin
| Most likely caused by group B strep
39
What counts as neonatal hypoglycaemia?
<2.5 mmol/L - lack of glycogen stores in neonates
40
What type of fluids would you give a child?
0.9% NaCl + 5% glucose + 10mmol KCl
41
What is normally a bolus of fluid for a child?
20 mls/kg 0.9% NaCl
42
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
43
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
44
What would you see in an ABG of metabolic acidosis?
| Name 3 causes
pH < 7.35
HCO3 < 22
sepsis, DKA, drugs, alcohol, renal failure
45
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
46
What would you see in an ABG of metabolic alkalosis?
| Name 3 causes
pH >7.45
HCO3 > 44
vomiting, alkalosis, hypokalaemia, burns
47
What causes retinopathy of prematurity?
vessels grow in the back of the eye due to too much oxygen causing blindness
Treat with lasers
48
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
49
What is the most common type of leukemia in children?
Acute lymphoblast leukemia - B and T lymphocytes abnormal
| Acute > 20% blasts
50
What are the 4 types of leukemia?
ALL, CLL, acute myeloid leukemia AML, CML
51
What are the symptoms of leukemia?
anaemia, flu-like symptoms, bleeding, bruising, enlarged spleen, enlarged lymph nodes
52
What is the treatment of leukemia?
chemo, clinical trials, anti-microbes, BM transplant
53
How do you estimate the weight of a child?
(Age +4) x2
54
What are three symptoms of anaphylaxis?
uricaria, itching, angioedema, wheeze, stridor, SOB, tachycardia, abdominal pain, collapse, hypotension
55
How would you treat anaphylaxis?
ABCDE, o2, IV fluids, IM adrenaline, hydrocortisone IV, antihistamines
Measure tryptase
56
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
```
57
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
58
What is VZIG?
varicella zoster immune globulin IgG
59
What is MAS?
Meconium aspiration syndrome
60
What treatment would you give a baby for group B strep?
benzylpenicillin and gentamicin
61
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
62
What is one thing you could use to treat brain haemorrhage in newborns?
vitamin K
63
What promotes ductus arterosis closure in first 48 hours of birth?
cyclo-oxygenase inhibition
64
What are 3 causes of a non-blanching rash?
meningococcal septicaemia, ALL, congenital bleeding disorders, NAI, HSP (henoch-schonlein purpura)
65
What is HSP?
Henoch-Schonlein purpura
| IgA mediated small vessel vasculitis
66
What is Kawasaki disease?
medium sized vessel vasculitis
| MYHEART (mucosal involvement, hand and feet, eyes, adenopathy, rash, temp)
67
What is DIC?
disseminated intravascular coagulation - symptom of meningococcal septicaemia
68
What is on an LP of meningoccocal septicaemia?
low glucose, high protein, cloudy
69
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
70
What is chickenpox and how would you describe the rash?
varicella zoster virus
| widespread, erythematous, raised, vesicular blistering lesions
71
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
72
What is impetigo and how would you treat it?
Staph aureus
golden crust around nose or mouth
Treat - topical fusidic acid, flucloxacillin
73
What is erythema infectiousum?
Slapped cheek
Parvovirus B19
- can spread to uper arms
risky for kids with sickle cell or thalassemia
74
What is seborrhoeic dermatitis?
cradle cap
75
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
76
What is erythema multiforme?
central target lesion - often caused by drugs, infection or idiopathic
77
What does severe combined immunodeficiency cause?
low B and T lymphocytes and immunoglobulins
78
How would you monitor and treat Kawasaki disease?
recurrent echocardiogram is vital- to show dilation and aneurysm of coronary arteries
Aspirin, IVIG
79
What is obstructive shock?
physical obstruction of great vessels of heart e.g. PE
80
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
81
What is the 24hr management priority after diagnosis of AML?
tumour lysis syndrome
82
What proteins are deficient in haemophilia?
factor VIII and IX
83
Name 3 differentials for non-blanching rash
Henoch-Schonlein Purpura
meningococcal septicaemia
capillary rupture due to increased pressure
84
What is a greenstick fracture?
one side of cortex buckled and one side broken
85
What are the normal ages of puberty?
Girls 10-14
| Boys 12-16
86
What are normal testicular volumes?
about 4mL volume at puberty, 12.5-14mL adult
| measured by orchidometer
