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FACEM > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Risk factors for intussuception

A 
Previous intussusception
Meckels diverticulum 
HSP
Lymphoma
Recent bowel surgery
Recent rotavirus vaccine
Male 
2m - 2yrs
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2
Q

Intussusception history & exam

A

Episodic distress (pain, pallor, drowsy, vomiting, diarrhoea)

RUQ mass, abdominal distension, guarding, hyperactive bowel sounds

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3
Q

Intussusception XR & US findings

A

XR: soft tissue mass RUQ, lack of air in RLQ, crescent lucency bowel gas, SBO, pneumoperitoneum

US: Target sign, pseudokidney

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4
Q

Intussusception treatment

A

Enema if less than 24 hours
Nasogastric tube
Antibiotics
Fluids

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5
Q

Relative ketamine CI

A 
Less than 6 months
Tongue laceration
Significant cardiac disease
Glaucoma
Porphyria
Psychosis
Procedure >20mins
Known difficult airway
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6
Q

Paediatric Ataxia

A

Cerebellar ataxia (normal LOC, nystagmus, recent viral illness)
Drugs: phenytoin, benzo, opioids
Post infectious demyelination encephalmyelitis
Basilar Migraine (headache, vertigo)
GBS (opthalmoplegia of vertical gaze)
Tumour
Trauma

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7
Q

One pill kill

A 
CCB
TCA
Opioids
Propranolol
Theophylline
Venlafaxine
Baclofen
Clozapine
Carbamazepine
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8
Q

AOM red flags & complications

A 
Unilateral
Indigenous
Cochlear implant
TM rupture
Systemically unwell
Mastoiditis
CN VII palsy
Cholesteatoma
Intracranial infection
Sinus thrombosis 
Malignant otitis media
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9
Q

BRUE definition

A 
Marked change in breathing, tone, colour or LOC
Complete return to baseline state
No medical explanation
<1 minute
<1 year old
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10
Q

Low risk of BRUE

A 
>2 months old
<1 minute
Not premmy (>32/40; corrected >45/40)
No CPR required
First episode
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11
Q

Criteria for Kawasaki Disease

Complete & Incomplete

A

Fever >5/7 + 4 of:

  • bilateral non-purulent conjunctivitis
  • cervical LN >1.5cm
  • polymorphous rash
  • lip and oral hyperaemia
  • painful hyperaemic hands & feet
Fever 5/7 + 2 criteria or
Fever 7/7 without another explanation and 3:
- anaemia
- plts 450+
- albumin <30
- raised ALT
- WBC >15
- WBC in urine or +ve ECHO
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12
Q

Kawasaki differential & investigations

A

GAS, scarlet fever, rheumatic fever, TSS, SJS, adenovirus

ECHO, raised CRP/ESR, raised LFT, ASOT, FBE (platelets raised at 2 weeks)

Note: common findings arthritis, aseptic meningitis, sterile pyuria

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13
Q

Kawaski management

A

IVIG 2g/kg
Aspirin 5mg/kg at least 6 weeks or until ECHO normal
Prednisolone 2mg/kg if high risk
(Shock, <1yr, Asian, cardiac or liver dx)

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14
Q

Kawasaki Complications

A 
Coronary artery aneurysm
Peripheral limb ischaemia
Valve regurgitation
Pericardial effusion
Aseptic meningitis
Myocarditis
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15
Q

Criteria for septic arthritis & bugs

A

Kocher criteria/

  • NWB
  • Temp >38.5
  • ESR >40
  • WBC >12

1: 3%
2: 40%
3: 93% (OT)
4: 99% (OT)

Bugs: S.Aureus, GAS, GBS, Haem influenza
Salmonella in sickle cell

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16
Q

Risk of recurrent febrile convulsion

A 
<1 year
Family hx febrile convulsion
Repeated previous seizures
Focal seizure
Brief duration between fever and onset
17
Q

Simple vs complex febrile convulsion

A 
Simple:
Generalised
<10 mins
Complete recovery 1hr
No recurrence within same illness
18
Q

Risk factors in febrile convulsion to progress to epilepsy

A

Family hx of epilepsy
Neurodevelopmental problem
Prolonged or focal seizure
Febrile status

Risk from 1% up to 10%

19
Q

Causes paediatric scrotal swelling

A 
Torsion
Incarcerated hernia
Torted appendage (gradual, tender upper pole, blue dot)
Hydrocoele (painless, transilluminate)
Variceole (painless, bag of worms)
Tumour 
Idiopathic scrotal oedema
Orchitis
20
Q

Rapid Nasogastric Rehydration

A

25ml/kg/hr for 4 hours

21
Q

Reasons to give slower NG hydration

A

<6 months
Significant abdominal pain
Co-morbidities

Replace deficit over 6 hours then maintenance

22
Q

Maintenance IV fluids

A

4ml/kg/hr for first 10kg
2ml/kg/hr for next 10kg
1ml/kg/hr for remaining kg

5% dextrose and 0.45% saline

23
Q

Difference in calculation burn BSA in kids

A

Head 9% (F&B)
Arms 4.5% (F&B)
Legs 7% (F&B)
Bum 2.5% x 2

24
Q

Poor prognosis in kids with drowning

A 
Immersion time 5mins
Rectal temp <30 degrees
Time to effective ALS 10 minutes
CPR in progress when arrive to ED
GCS <5
ABG pH <7.1 on arrival
No respiratory effort within 40 mins
25
Q

Phases of drowning

A

Immersion
Breath hold
Laryngospasm
Aspiration

26
Q

Discharge drowning

A 
8 hours post drowning
No symptoms
Normal Resp exam
Normal vitals
No social safety concerns
(Social work should be involved)
27
Q

Conns & Modell Drowning Score

A

2 hours post drowning

A: Alert
B: Drowsy
C: Unresponsive

28
Q

Gartland criteria

A

Supracondylar fracture

1: undisplaced. Above elbow backslab and GP 3 weeks
2: angulated but posterior cortex intact. Above elbow 3/52 and # clinic
3: displaced posteriorly - surgery

29
Q

Post tonsillectomy bleed management

A 
Sit up
Volume resuscitate 
TXA 15mg/kg
DDAVP 0.3mcg/kg
Suction
Metoclopramide
Direct pressure (co-phenylcaine, txa, adrenaline soaked gauze)
IV Abx
Gargle H2O2
Suck ice
30
Q

Pertussis

  • when give Abx
  • complications
  • what Abx
  • when not infectious
A

Abx: within 2 weeks of cough or admitted to hospital

Apnoea, cyanosis, pneumonia

Azithro 10mg/kg PO & clarithro 7.5mg/kg BD
or Bactrim 4-20mg/kg BD

Back to school after 5 days tx or 3 weeks cough

31
Q

Causes neonatal jaundice

A

<24hrs pathological
Term TCB should be <250

Increased lysis:

  • ABO/Rh incompatibility
  • RBC defect (G6PD)
  • sepsis

Reduced conjugation:

  • Criglar-Nijar
  • Biliary atresia
  • Hepatitis
  • Hypothyroidism
  • Hypopituitarism
  • Bowel obstruction

Physiological:

  • breast milk
  • dehydration (first few days BF babies)
  • haematoma breakdown
32
Q

Red flags limp

A 
>7 days
Nocturnal pain
Change to urinary/bowel function
Systemic symptoms
Unable to weight-bear
Severe localised joint pain
33
Q

Red Flags Limp exam (3)

A

Muscle wasting
Fever
Petechia or ecchymosis

34
Q

Paediatric Syncope

A 
Vasovagal
Arrhythmogenic (WPW, QTc, Brugada)
Structural cardiac (HOCM, AS, CHD)
Reflex Anoxic Episodes
Metabolic: hypoglycaemia, hyponatraemia
Neurogenic: Vertigo, migraine, micturation
35
Q

Normal paediatric variation

A 
sinus tachycardia/arrhythmia
RSR pattern V1 (RBBB but say this)
Dominant R wave in V1
TWI V3 & V2
TWI III

FACEM (8 decks)

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