Paediatrics Flashcards
Which blood vessels does the PDA connect?
Pulmonary artery and descending aorta
What type of murmur do the following create:
- ASD
- VSD
- PDA
- Coarctation in aorta
- Midsystolic crescendo-decrescendo
- Loud pansystolic murmur
- Continuous machinery murmur
- Loud systolic murmur in left intraclavicular region
How can someone present with an ASD in later life?
Stroke - a clot from a DVT can bypass lungs
What are the 4 features of Tetralogy of Fallot?
What murmur does it present with?
What will you see on CXR?
Overiding aorta, VSD, pulmonary stenosis, RVH
Loud ejection systolic
Boot shaped heart
What cardiac arrhythmia is associated with Ebstein’s anomaly?
Wolff-Parkinson-White
What will you see on CXR with transposition of the great arteries?
Heart looks like an “egg on a string”
What is the medical management of heart failure in children? (4)
When should oxygen not be used?
What other management should you consider for a child presenting with heart failure and failure to thrive?
ACE-I (e.g. catopril), diuretics (e.g. furosemide), prostaglandins, inotropes (e.g. dobutamine)
Duct-dependent heart failure as can cause ducts to close
High calorie feeds
What is tested for on the newborn heel prick test?
Sickle cell, cystic fibrosis, congenital hypothyroidism, 5 metabolic disorders
What are you likely to see on neck x-ray with epiglottitis?
Thumbprinting
What are signs of respiratory distress? (8)
Raised respiratory rate Use of accessory muscles Intercostal and subcostal recession Nasal flaring Tracheal tug Head bobbing Cyanosis Abnormal airway sounds
What is the characteristic cough of croup?
What symptoms would suggest severe croup? (2)
When should croup usually resolve in mild cases?
Seal-like barking cough
Agitation, lethargy
48h
What are the signs and symptoms of anaphylaxis?
- A (3)
- B (4)
- C (3)
A - stridor, hoarseness, swelling in larynx
B - tachypnoea, wheeze, cyanosis, low O2%
C - hypotension, pale, clammy
What is the NICE criteria for diagnosing bronchiolitis? (4)
1 to 3 day history of coryzal symptoms with :
Persistent cough AND
Either tachypnoea or chest recession AND
Either wheeze or crackles on auscultation
How long does it take for bronchiolitis to resolve?
2-3 weeks
What can happen with severe coughing fits in whooping cough? (3)
How long does it take for whooping cough to resolve?
What should you do after managing child?
Vomiting, apnoea, LOC
8 weeks
Notify Public Health
Which tests can you use to diagnose cystic fibrosis? (2)
What is the general management of CF? (4)
Sweat test, genetic testing
MDT :) chest physiotherapy, bronchodilators, prophylactic antibiotics, high calorie diet
What can you assess to determine dehydration in a child? (9)
Body weight - >4% is significant, >7% is severe Skin turgor Tears (present vs absent) Urine output Eyes (sunken vs not sunken) Anterior fontanelle (sunken vs not sunken) Mucuous membranes Blood pressure Heart rate
How do you cause a hyponatraemic dehydration?
Lose sodium and water at same rate with vomiting/diarrhoea
However, drink water to compensate without salts = hyponatraemic
How many stools and vomits put you at higher risk of dehydration in 24h?
> 5 stools
>2 vomits
What are the principles of management of gastroenteritis in children? (2)
How should you manage shock caused by gastroenteritis? (3)
Isolate child
Prevent dehydration e.g. ORS, continue to breastfeed
Fluid bolus (20ml/kg) Then maintenance fluids Monitor U&Es, glucose, weight daily
When does gastroenteritis tend to resolve?
Diarrhoea - 5-7 days, resolves completely in 2 weeks
Vomiting - 1-2 days, resolves completely by 3 days
What are the complications of gastroenteritis? (4)
Lactose intolerance
IBS
GBS
HUS
What are the complications of GORD in children? (4)
Failure to thrive
Oesophagitis
Recurrent pulmonary aspiration
Sandifer syndrome - severe arching of spine, dystonic neck posturing
What are the causes for urgent referrals for constipation in children? (7)
What are some medical causes of constipation that can initially be managed in primary care whilst referring? (3)
Cystic fibrosis Hirschprung's Anal stenosis Spina bifida Cerebral palsy Intestinal obstruction Sexual abuse
Coeliac disease
Cow’s milk protein allergy
Congenital hypothyroidism
What examination is very important (!) when investigating constipation?
Lower limb neurological exam !
What are the physical and psychological causes of emaciation in children?
Endocrine: T1DM, hypothyroidism, Addison’s
GI: coeliac, IBD, achalasia
Malignancy
JIA
Psychological: eating disorder, depression, OCD
Autism
What electrolyte abnormalities would you expect to see in refeeding syndrome? (5)
Hyponatraemia Hypokalaemia Hypomagnesaemia Hypophosphataemia Hypocalcaemia
What are some of the features of refeeding sydrome? (4)
Rhabdomyolysis
Arrhythmias
Seizures
Sudden Death
How do you manage refeeding syndrome? (5)
Pabrinex Refer to dietician Slowly reintroduce food Monitor fluid balance Monitor electrolytes
How do you treat intussuception?
Rectal air insufflation
What features would suggest NAI? (7)
Delay in seeking help
Vague, inconsistent history
Injury not compatible with history/developmental age of child
Injuries of different ages
Multiple A&E attendances and to different sites
Pattern/artefact burns or injuries
Inappropriate affect from child or parent
Which percentage of weight loss in the newborn would indicate a referral to paediatrics?
Weight loss can be normal in a newborn. By what week should they return to their birth weight?
> 10%
3 weeks
What is the normal feed for a newborn?
150ml/kg/d if <1 month (every 4 hours)
100ml/kg/d if >1 month
What drop in centiles on the growth chart would warrant a referral to paediatrics?
2 or more centiles OR anyone below 2nd centile
NB, if below 9th centile, then just 1 drop; if above 91st centile, then 3 or more
What are important infective causes of fever to rule out according to NICE? (5)
Meningitis Pneumonia UTI Herpes simplex encephalitis Kawasaki
What are the most common causes of meningitis in:
- Under 3 months
- Over 3 months
- GBS, E. Coli, Listeria
2. Neisseria meningitidis, S pneumonia, Haemophilus influenzae (if not vaccinated)
What are aseptic causes of meningitis?
Which cause should be considered in the immunocompromised?
Viral, fungal, TB, inflammatory, malignancy, sarcoidosis
Fungal
What blood test is required to test for N meningitidis?
PCR
Which antibiotic is most commonly used to treat meningitis?
Which antibiotic is required for:
- GBS
- Listeria
Ceftriaxone
- Cefotaxime
- Amoxicillin
When should dexamethasone not be used in the treatment of meningitis? (2)
If over 12h since starting antibiotics
Meningococcal septicaemia
What increases the risk of developing bacterial meningitis (environmental and medical)?
Overcrowded day care
Low family income
Maternal infection during birth
Basal skull fracture
Periorbital or orbital cellulitis, sinusitis, septic arthritis
Asplenism
What are the complications of meningitis?
- Acute (6)
- Long term (5)
Seizures, raised ICP, metabolic disturbance, coagulopathy, anaemia, coma, death
Hearing impairment, neurological impairment, epilepsy, learning or developmental difficulties, psychosocial problems
What is the long-term management after recovery from meningitis? (2)
Refer to paediatrician for follow up
Hearing assessment at 4 weeks
What can cause a prolonged fever in children? (2)
Lyme disease
Kawasaki disease
What are the important differentials for an acutely unwell neonate? (4)
Sepsis
Meningitis
Inborn errors of metabolism
NAI
What investigations should you order for an acutely unwell neonate?
- Bloods
- Imaging
- Microscopy
- FBC, U&Es, LFTs, CRP, lactate, blood gas, blood cultures, ammonia, bicarbonate, glucose, coagulation
- CT head or cranial USS, CXR
- LP, urine dip and culture
What should you calculate if a neonate presents with metabolic acidosis?
Anion gap
What are the differentials for a non-blanching rash in a child?
- Will cause child to be unwell
- Child will be generally well
- Meningicoccal septicaemia, Leukaemia, DIC, HUS, measles
2. ITP, HSP, aplastic anaemia
What is are the investigations and follow-up for a child presenting with HSP?
U&Es, eGFR, urine analysis, PCR, blood pressure
BP and urine for one year checking for renal involvement
When should children generally recover from ITP?
When should you refer?
What management options are there for ITP? (3)
6 weeks - can take up to 3 to 6 months to fully revoer
6 months - examine bone marrow for inherited disorders
Tranexamic acid for bleeding, steroids, immunoglobulins
What are features of the following types or UTI:
- Atypical (6)
- Recurrent (3)
- Poor urine flow, septic, non- E coli, raised creatinine, abdominal mass, failure to respond to antibiotics in 48h
- 2 or more upper UTI, 1 of both upper and lower UTI, 3 lower UTIs
When should the following scans be used to investigate UTI in children?
- Renal USS
- MCUG
- DMSA
- <6 months, atypical UTI
- <6 months with recurrent or atypical UTI
- All those with recurrent UTI, <3 years with atypical
At what age should interventions be trialled in children with enuresis?
What are these interventions? (2)
Over 5 years
Enuresis alarm, desmopressin
What specific signs are found in someone with Duchenne muscular dystrophy? (2)
What blood test will be raised in Duchenne muscular dystrophy?
Gower’s sign, pseudohypertrophy of calves
Creatinine kinase
Which conditions are ASD associated with? (3)
Fragile X
Tuberous sclerosis
Williams syndrome
What are some causes of delayed walking?
Neurological: cerebral palsy, spina bidifia, central cause
Neuromuscular i.e. Duchenne’s
Environmental: bottom shuffler, psychosocial deprivation
Developmental dysplasia of hip
Metabolic conditions
Hypothyroidism
When should the insulin be started in DKA in children?
1-2 hours after starting IV fluids
What are the complications of DKA in children?
Cerebral oedema
Hypokalaemia
VTE
