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Year 5 > Paediatrics 9 > Flashcards

Paediatrics 9 Flashcards

1
Q

Diffuse brain injury

A
  • Concussion- often mild, usually normal CT
  • Diffuse axonal injury- due to shearing forces. Associated with high velocity and deceleration. In the CT you may see widespread punctate haemorrhages
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2
Q

What exacerbates secondary brain injury

A
  • Hypoxia
  • Hypercarbia and iatrogenic hypocapnia
  • Hypotension and hypertension
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3
Q

Respiratory arrest

A
  • The cessation of breathing
  • Causes: obstructive airway, COPD, asthma, stroke, head injury, drug overdose
  • Clinical presentation: gasping or irregular breathing, cyanosis, unconsciousness and absence of breath sounds
  • Investigations: ABG, obs
  • Management: Endotracheal intubation or tracheostomy, ventilation
  • Once stabilised transfer the patient to HDU or ICU for ongoing monitoring
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4
Q

Features of respiratory arrest

A
  • Agonal breathing: gasping, laboured breaths that occur infrequently and irregularly
  • Absent breathing
  • Cynaosis, decreased consciousness
  • Silent chest on auscultation
  • Dysphonia, nasal flaring
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5
Q

Rubella

A
  • Viral illness transmitted via respiratory droplets
  • Prevention: MMR vaccine
  • Symptoms: fever, coryza, arthralgia, post-auricular lymphadenopathy. A rash that begins on the face and moves to the trunk
  • Investigations: diagnosed with serological testing like rubella specific IgM
  • Supportive treatment with antipyretics and analgesia. Need to be isolated to prevent spread particularly against pregnant people
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6
Q

Rubella pregnancy

A
  • Can cause congenital rubella syndrome in pregnant women (especially in first 20 weeks)
  • Fetal abnormalities: Cataracts, Deafness, Patent ductus arteriosus, Brain damage
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7
Q

Self harm paediatrics

A
  • Causing harm to oneself physically
  • Associated with BPD, depression, anxiety disorder, PTSD and eating disorders
  • Types: cutting skin, burning oneself, hitting oneself, overdosing on medication
  • Aim is to prevent immediate risk and for long term prevention of recurrence
  • Management: CBT and antidepressants
  • If significant risk can be hospitalised
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8
Q

Small for gestational age: complications

A
  • Iatrogenic prematurity
  • Antenatal or intrapartum asphyxia
  • Operative delivery
  • Perinatal death including stillbirth
  • Neonatal hypoglycaemia and hypocalcaemia
  • Necrotising enterocolitis
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9
Q

SGA delivery

A
  • <37 with absent/reverse end diastolic flow measured on a umbilical artery doppler= recommend Caesarean section
  • <37 weeks with abnormal end diastolic flow measured on a umbilical artery doppler= offer induction of labour
  • At 37 weeks with normal umbilical artery doppler= offer induction of labour
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10
Q

SGA and severe SGA categories

A

SGA = estimated foetal weight (EFW) OR Abdominal Circumference (AC) is less than the 10th centile on a customised growth chart

Severe SGA =EFW OR AC less than the 3rd centile on a customised growth chart

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11
Q

SGA diagnosis

A

Serial ultrasound scans are used for diagnosis of SGA performed from 26-28 weeks gestation. US measurement of size and assessment of wellbeing with umbilical artery doppler is performed every 3-4 weeks until delivery

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12
Q

SGA screening

A

Any woman with one major risk factor will be referred for serial growth scans, which are essential to monitor and diagnose SGA. If a woman has three or more minor risk factors, she should be referred for uterine artery Doppler at 20-24 weeks gestation. Women with abnormal uterine artery Doppler should also be referred for serial growth scans.

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13
Q

SGA risk factors

A
  • Major: previous stillbirth, previous SGA fetus, cocaine use, >40, maternal disease, threatened miscarriage, low PAPP-A, pre-eclampsia, cigarette somking
  • Minor: nulliparity, IVF, maternal BMI <20 or >25, previous pre-eclampsia
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14
Q

Causes of SGA

A
  • Constitutionally small
  • Non-placental mediated growth restriction: chromosomal or structural abnormalities, fetal infection, inborn errors of metabolism
  • Placental mediated growth restriction: pre-eclampsia, autoimmune disease, thrombophilia, renal disease and essential hypertension
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15
Q

Management of SGA

A
  • Conservative: smoking cessation, drug counselling
  • Medical: if SGA fetus between 24 and 35+6 weeks gestation get a single course of antenatal corticosteroids
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16
Q

Soft tissue injury

A
  • Can be caused by sports, recreational activities or accidental falls. Tend to heal in a few weeks
  • Types: Sprains, strains (pulled hamstring), bruises and cuts
  • Symptoms: pain, swelling, bruising, limited range of movement, weakness, tenderness
  • Management RICE method, analgesia, possibly physical therapy
  • RICE: Rest, Ice, Compression, Elevation
  • Prevention: proper warm up and stretch, prevent overuse, use protective gear
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17
Q

Causes and complications of Subarachnoid haemorrhage

A

Causes of SAH:
- head injuries (traumatic SAH)
- Spontaneous SAH: intracranial aneurysm (berry aneurysm), arteriovenous malformation, pituitary apoplexy, mycotic (infective) aneurysm

Complications of SAH; Re-bleeding, hydrocephalus, vasospasm, hyponatraemia (due to SIADH), seizures

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18
Q

SAH clinical features and examination

A
  • Clinical features: thunderclap headache, N+V, photophobia, neck stiffness, altered consciousness, focal neurological signs (cranial nerve palsies and speech distubrance)
  • Fundoscopy: subhyaloid haemorrhage
  • Examination: positive kernig or Brudzinski’s sign, papiloedema
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19
Q

SAH investigations

A
  • Non-contrast CT: if done within 6 hours and no evidence of blood then dont do an LP
  • Do an LP: if CT is done >6 hours after symptom onset and is normal. LP should be done >12hr after symptoms. Will see xanthochromia
  • CT intracranial angiogram: once spontaneous SAH is confirmed to identify causative agent
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20
Q

SAH management

A
  • Refer to neurosurgery: treated with a coil
  • Oral nimodipine: to prevent vasospasm
  • Supportive: bed rest, analgesia, VTE prophylaxis, stop antithrombotics
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21
Q

Subdural haemorrhage

A
  • bleeding between the dura and arachnoid matter: often due to significant head trauma causing rupture of bridging veins. Can occur spontaneously. Can be either acute or chronic
  • Presentation: altered consciousness, headache, vomiting, focal neurological deficits
  • Chronic changes: cognitive changes, gait disturbance or hemiparesis
  • Diagnosis: CT shows a crescent shaped hyperdense blood collection (banana)
  • Management: surgical intervention (decompressive craniotomy) with medical management
22
Q

Testicular torsion: basics

A
  • twist of the spermatic cord resulting in testicular ischaemia and necrosis.
  • most common in males aged between 10 and 30 (peak incidence 13-15 years)
23
Q

Testicular torsion features

A
  • pain is usually severe and of sudden onset
  • the pain may be referred to the lower abdomen
  • nausea and vomiting may be present
  • on examination, there is usually a swollen, tender testis retracted upwards. The skin may be reddened
  • cremasteric reflex is lost
  • elevation of the testis does not ease the pain (Prehn’s sign)
  • Lie of the testis may be horizontal (bell-clapper position)
  • In neonatal torsion the patient may be asymptomatic and present as a firm, hard and enlarged testis in a blue scrotum
24
Q

Testicular torsion management

A
  • treatment is with urgent surgical exploration with fixation of the testicles with orchidoplexy
  • if a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral.
  • Manual detorsion can be performed if the patient presents early
  • Post operatively the patient is provided with scrotal support and advised bed rest for 24 hours and refrain from heavy lifting or exercise for the first few weeks
25
Q

Testicular torsion investigations and complications

A
  • Doppler ultrasound scan: shows lack of blood flow to the testis
  • Surgical exploration confirms the diagnosis

Complications: atrophy or necrosis of the testis, infection, subfertility

26
Q

Tonsilitis

A

Inflammation of palatine tonsils (often due to infection)

  • Causes: Viruses (rhinovirus, coronavirus, RSV, EBV); bacteria (mainly group A beta-haemolytic streptococci (strep pyogenes) = ‘strep throat’)
  • Symptoms: Throat pain; odynophagia; referred ear pain; hoarse voice (esp. if associated laryngitis); headache; small children may have abdominal pain
  • Signs: Red, swollen tonsils +/- exudate; fever; cervical lymphadenopathy
  • Investigations: Usually not needed; sepsis 6 if septic; consider throat swab (esp. for streptococci)
  • Refer: Difficulty breathing; dehydration; systemic illness/possible sepsis; peritonsillar/retropharyngeal abscess
27
Q

Centor criteria

A
  • Exudate on tonsils (1 point)
  • Tender anterior cervical lymph nodes (1 point)
  • Absence of cough (1 point)
  • Fever >38 degrees (1 point)
28
Q

FeverPAIN

A
  • Fever during previous 24 hours
  • P – Purulence (pus on tonsils)
  • A – Attended within 3 days of the onset of symptoms
  • I – Inflamed tonsils (severely inflamed)
  • N – No cough or coryza
  • Chance of having bacterial tonsilitis
  • Prescribe antibiotics if >4
29
Q

Tonsilitis management

A
  • Safety net: if pain hasn’t settled >3 days or fever >38.3
  • Conservative: Explanation and reassurance, ‘delayed prescription’
  • Medical: Analgesia/antipyretics (paracetamol/ibuprofen); topical analgesia (benzydamine spray); consider antibiotics if Centor score >3 (10 days penicillin V/clarithromycin)
30
Q

Tonsilitis antibiotics

A

A Centor criteria score of 3/4 would warrant prescribing antibiotics or evidence of systemic upset/immunosuppression would warrent a course of antibiotics:

  • 1st line: Penicillin V for 5-10 days
  • Alternative in penicillin allergy: Clarithromycin/Erythromycin
31
Q

Tonsilitis surgery

A
  • Tonsillectomy if recurrent episodes (3 yearly for 3 years; 5 for 2 years or 7 in 1 year)
  • Also indicated for obstructive sleep apnoea from enlarged tonsils/adenoids
  • Admit for drainage if peritonsillar abscess forms
32
Q

Tonsilitis complications

A
  • Chronic tonsillitis
  • Peritonsillar abscess, also known asquinsy
  • Otitis mediaif the infection spreads to the inner ear
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
33
Q

Toxic shock syndrome

A
  • Life threatening condition: caused by S.aureus and S.pyogenes
  • Causes: Tampons, skin infections (abscess, boils, cellulitis), burns, URTI
  • Symptoms: Fever, Hypotension, rash (sunburn like rash that leads to desquamation), Sepsis symptoms
34
Q

Treatment of toxic shock

A
  • Hospitalisation and ICU
  • Broad spectrum antibiotics
  • IV fluids and vasopressors
  • Surgical intervention for source control
  • Supportive care
35
Q

Viral upper respiratory tract infection

A
  • Causes: Rhinovirus, Influenza virus, Coronavirus and Adenovirus
  • Clinical diagnosis
  • Symptoms: nasal congestion, sore throat, cough, tiredness, earache, hoarseness and fever
  • Signs: erythema at the back of the throat, nasal discharge, tender cervical lymphadenopathy
  • Supportive management: admission for frail or elderly. Lasts for 7-10 days. Advise paracetamol, fluids and rest
  • Complications: Sinusitis, Otitis media, secondary bacterial infection i.e. pneumonia, exacerbations of asthma or COPD
36
Q

UTI: causative organisms and predisposing factor

A

Causative organisms: E.coli (80%), Proteus, Pseudomonas

Predisposing factors
- Incomplete bladder emptying: infrequent voiding, hurried micturition, obstruction by full rectum due to constipation, neuropathic bladder
- Vesicoureteric reflux: a development anomaly found in 35% of children with a UTI
- Poor hygiene

37
Q

UTI and gender

A

Urinary tract infections (UTI) are more common in boys until 3 months of age (due to more congenital abnormalities) after which the incidence is higher in girls.

38
Q

UTI presentation at different ages

A
  • infants: poor feeding, vomiting, irritability, lethargy, offensive urine
  • younger children: abdominal pain, fever, dysuria
  • older children: dysuria, frequency, haematuria. Less likely to get fever as you age
  • features which may suggest an upper UTI include: temperature > 38ºC, loin pain/tenderness
39
Q

NICE guidelines for checking urine samples in a child

A
  • if there are any symptoms or signs suggestive or a UTI
  • with unexplained fever of 38°C or higher (test urine after 24 hours at the latest)
  • with an alternative site of infection but who remain unwell (consider urine test after 24 hours at the latest)
40
Q

Urine collection methods

A
  • clean catch is preferable
  • if not possible then urine collection pads should be used
  • cotton wool balls, gauze and sanitary towels are not suitable
  • invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible
41
Q

UTI management

A
  • infants <3 months old should be referred immediately to a paediatrician
  • children >3 months with an upper UTI should be considered for admission to hospital. If not admitted give oral antibiotics i.e. cephalosporin or co-amoxiclav for 7-10 days
  • children >3 months old with a lower UTI should be treated with oral antibiotics for 3 days, usually trimethoprim or nitrofurantion. Parents should bring the children back if they remain unwell after 24-48 hours
  • antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs
  • Lower UTI’s are usually treated with nitrofurantoin, upper UTI’s are usually treated with cephalosporin
  • If recurrent UTI’s refer to secondary care
42
Q

Investigations following a UTI

A
  • Renal ultrasound- only if they have an atypical UTI
  • Micturating cystourethragram- to assess for abnormal bladder function
  • DMSA scan- 4 to 6 months after acute infection to detect renal parenchymal defects
43
Q

What investigations are recommended for children under 6 months after a first atypical urine infection or recurrent UTI?

A

Renal ultrasound, DMSA and MCUG.

Gold standard for renal cortical scarring: DMSA

44
Q

When is a UTI classed as atypical

A
  • Poor urine flow
  • Abdominal or bladder mass
  • Raised creatinine
  • Septicaemia
  • Failed to respond to treatment with suitable antibiotics within 48 hours
  • Infection with non E.coli organisms
45
Q

UTI diagnosis

A
  • Positive leukocytes and nitrites on urine dip
  • Positive urine culture with appropriately collected urine (clean catch; non-contaminated collection pad/catheter sample/suprapubic aspirate)
46
Q

Urticaria

A
  • Hives’: common dermatological condition caused by transient pruritic wheals in the dermis
  • Rah: pale pink raised skin, pruritic
  • Either acute (<6 weeks) or chronic (>6 weeks)
  • Due to mast cell degranulation to an allergen
  • Clinical diagnosis but can use skin prick test or serum tryptase levels
  • Management: avoid triggers and antihistamine. First line: non sedating antihistamine (loratadine) then sedating (chlorpenamine). Prednisolone if severe or resistant
47
Q

Viral exanthema

A
  • A widespread maculopapular rash caused by viral infections
  • Systemic symptoms: fever, malaise and lymphadenopathy
  • Causes: measles, rubella, varicella zoster, erythema infectiosum (fifth disease) and roseola (6th disease)
  • Investigations: serology and PCR
  • Management: antipyretics and analgesia
48
Q

Bacterial causes of gastroenteritis

A
  • Staphylococcus aureus: usually found in cooked meats and cream products.
  • Bacillus cereus: mainly found in reheated rice.
  • Clostridium perfringens: usually found in reheated meat dishes or cooked meats.
  • Campylobacter
  • coli including E.coli 0157 (which can cause haemolytic uraemic syndrome)
  • Salmonella, Shigella
49
Q

Viral causes of gastroenteritis

A
  • Rotavirus (most common cause of infantile gastroenteritis): part of the vaccination programme
  • Norovirus- most common cause of viral gastroenteritis of all ages
50
Q

Viral gastroenteritis

A
  • Clinical diagnosis: self-limiting episode of diarrhoea,nauseaandvomiting lasting <14 days.
  • Before starting IV fluids do an FBC and U&E
  • Normally dont need stool sample unless presence of blood, long lasting diarrhoea recent travel or suspicion that its non-viral
  • Can get transient Lactose intolerance

Year 5 (24 decks)

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