Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Acem fellowship > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Sepsis definition

A

life threatening organ dysfunction caused by a dysregulated host in response to an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Toxic shock syndrome

A

septic shock caused by superantigens produced by toxin-producing staph aureus or strep pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

High risk factors for sepsis

A 
<2months
premature
unimmunised
immune def/supp
asplenic
indwelling lines
malignancy (neutropenic)
recent surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sepsis abx <2months

A

Amp 50mg/kg
Gent 7.5mg/kg >1month or 4mg/kg <1month
+ cefotaxmine 50mg/kg meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sepsis Abx >2months

A

cefotaxime 50mg/kg max 2gr
cipro 10mg/kg max 500mg if pen anaphylax

Septic shock:
Add gent 7.5mg/kg and vanc 15mg/kg max 750mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Septic shock PICU criteria

A 
fluid non-responder 40ml/kg
inotropes 
reduced LoC
hypotension
coagulopathy/DIC
lactate>4
toxic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Blood culture volumes

A

neonatal aerobic 1ml+

standard bottles 4ml+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Targets for fluid resus

A

U/O 1ml/kg/hr
improved mental state
nomal HR
CRT <2 normal perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TSS abx

A

cefotaxime 50mg/kg

lincomycin 15mg/kg (max 1.2gram)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Adrenaline doses

A 
push dose 1mcg/kg
infusion 0.05-0.1mcg/kg/min
Can go higher but more side effects 
===
add 1ml of 1:10,000 to 9ml n.saline = 10mcg/ml

==
Cardiac arrest 10mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Calcium gluconate doses

A

Calcium gluconate 10% in 10ml

0.5ml/kg = 0.11mmol/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

IV hydrocortisone dose

A

1mg/kg if known adrenal insufficiency or intotrope resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Septic shock DDx

A 
Anaphylaxis
cardiogenic shock inc congential cardiac, duct dependent lesions 
obstructive shock 
neurogenic shock 
hypovolaemic shock 
congential metabolic disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

warm shock

A 
vasoplegic
wide pulse pressure
flash CRT
tachycardia
bounding pulse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cold shock

A 
vasoconstricted
narrow PP
tachycardic
slow CRT
tend to be younger
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sepsis Ix

A 
Blood culture 
VBG -
lactate
base deficit 
Co2
glucose 
FBC -
plt (DIC)
WCC (hi or lo)
ECU -
Cr AKI
Coags (DIC)
LFTs - hi bili ALT if liver failure from MODs
LP - ?meningitis and no features of raised ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LP in septic shock

A 
Do not delay abx
do not perform if child has 
Reduced LoC
Focal neuro signs
 Raised ICP sx
Haemodynamic instability
resp compromise

send for WCC and PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sepsis signs

A 
fever
hypothermia
AMS (lethargy or agitated) 
abnormal HR, RR, CRT
petechia / purpura / widespread erythema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Resus end points

A 
CRT<2
Normal BP for age
Normal HR
warm
U/O 1ml/kg/hr
normal mentation
o2 sats >92%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NETS referral - Airway

A

airway obstruction - mod+ distress
Croup + 2 adrenaline + ongoing distress
symptomatic FB
post tonsil haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

NETs referral GI

A 
button battery 
FB - vomiting, secretions, drooling, unable to eat
acute GIB
insussception+shock
surgical abdo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

NETS referral Resp

A 
Despite max tx
hypoxia
apnoeic events 
resp support required
severe distress
congenital heart/lung dx
mediastinal mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

NETS referral Neuro

A 
Raised ICP signs 
VPshunt dysfunction
ICH with hi ICP
meningitis with shock/seizures/raised ICP
Status epilepticus
TM or GBS (potential to deteriorate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NETS referral cardiac

A 
congenital disease + 
resp distress
poor perfusion
arrhythmia
Altered LoC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
NETS referral endocrine
DKA + <5 yr pH <7.15 after 2 hours severe headache / altered LoC
26
NETs referral systemic
septic shock / TSS anaphylaxis with ongoing sxs despite tx pain OOP to clinical exam findings
27
Non-pharma pain Mx
``` Immobilise RICE Dressings distract toy/bubbles/phone Swaddle Skin to skin Feeding / dummy Breathing techniques ```
28
Sucrose dose
PO 0.1-0.5ml 2mins pre-procedure max 5ml/day <3month max 10ml/day >3month
29
Paracetamol dose
PO 15mg/kg/day IBW 4-6hourly (IV Q6H) Max 90mg/kg/day >1month
30
Ibuprofen dose
PO 10mg/kg/day 6-8hourly max 30mg/kg/day 2.4gram max
31
Fentanyl dose
IN 0.75-1.5mcg/kg Max 75mcg Q10min Divide between nostrils IV 0.5-1mcg/kg Q5-10min
32
Oxycodone dose
PO >12months 0.1-0.2mg/kg Q4hr max 5-10mg dose
33
Morphine dose
IV up to 0/05-0.2mg/kg | max 5-10mg 2-4hourly
34
Moderate dehydration (5-9%) signs
``` tachy lethargy tachypnoea sunken eyes dry MM decreased skin turgor CRT >2 ```
35
Severe dehydration -(>=10%) Shock
``` Reduced LoC Tachy Tachypnoea / kussmaul hypotensive pale/mottled cold weak pulse decreased skin turgor CRT >2++ Deeply sunken eyes ```
36
IVF bolus
0.9% NaCl 10-20ml/kg max 40ml/kg then likely need inotropes
37
IVfluid maintenance calc
0.9%Nacl+5% glucose 4-2-1 rule ml/hr ``` 4ml/kg 1st 10kg =4xweight 2ml/kg next 10kg =40ml + 2x(weight-10) 1ml/kg up to 60kg =60ml + (weight-20) ``` - 2/3 rate for unwell kids - Replace 5% over 24hours then remainder over next 24hours
38
Seizure Tx
Midazolam x2 IN/IM 0.3mg/kg IV/IO 0.15mg/kg Levetiracetam IV 40mg/kg over 5m (max 2.5gram) Phenobarbitone <1yr 20mg/kgover 20min (<1gr) Intubate - propofol 2-3mg/kg Roc 1.2mg/kg
39
Hyperkalaemia Tx | (5 drugs)
- Calcium gluconate 10% 0. 11mmol/kg - 10% dextrose 5ml/kg/hr - Actrapid 0.1u/kg/hr - Furosemide 1mg/kg - Sodium bicarbonate 8.4% 1mmol(1ml)/kg
40
Hypertonic saline dose
3% NaCl 3ml/kg over 10mins large vein
41
Intubation medication
ketamine 1-2mg/kg 200mg/2ml dilute to 20ml (10mg/ml) Rocuronium 1.2mg/kg 50mg/5ml vial (10mg/ml) 60sec onset Fentanyl 1mcg/kg pain 2-5mcg/kg induction 100mcg/2ml, dilute to 10ml (10mcg/ml) Propofol 2-3mg/kg
42
Mag sulfate dose
0.2mmol/kg over 20mins if pulse present | 10mmol/5ml
43
APLS Intervention (4)
15:2 compression/vent Adrenaline 10mcg/kg Defib 4j/kg Amiodarone 5mg/kg after 3rd shock if shockable
44
Weight estimate
(age+4)x2
45
ETT tube sizing
Age/4 + 3.5 for cuffed
46
Glucose dose
10% dextrose 2ml/kg
47
BP normal estimate
Agex2 +65mmHg
48
ETT tube depth estimate
>1yr Age/2+13 | <1yr weight/2 +8
49
``` Vital normal ranges Simplified 0-6month 6-12month 1-4years ```
0-6month HR 80-180 RR <40 BP 60-90 6-12month HR 70-150 RR <35 BP 90-100 1-4 HR 70-120 RR 20-30 BP 100 > 4 like adults
50
Unsettled baby red flags (3)
sudden onset irritability/cry Parental PND NAI risks as sign of abusive head trauma
51
Unsettled baby DDx (8)
``` NAInjury incarcerated inguinal hernia / torsion sepsis / infection hair tourniqet corneal abrasion?? Raised ICP Non-IGe cows milk allergy ```
52
Acute abdo pain | Non-abdominal causes (9)
``` DKA HSP Pneumonia Hip pathology UTI/pyelo testicular torsion sepsis sickle cell VOcrisis toxins/OD ```
53
Acute abdo pain Ix
``` urine - culture UTI ketone /glucose DKA protein/casts AKI/HSP pregnancy ``` VBG - pH, base deficit, electrolytes, lactate EUC - Cr AKI BSL - DKA, sepsis hypo LFT, lipase USS - appendix/pyelo/ureteric calc/cholecystitis/intersussception/ ovarian torsion AXR -obstruction CXR - pneumonia
54
Neonatal acute abdomen | DDx (5)
``` hirschsprung enterocolitis Nec enterocolitis incarcerated hernia volvulus intersussception ```
55
Infant/child Acute Abdo DDx (9)
``` pyloric stenosis meckel's diverticulum incarcerated hernia volvulus intersussception abdominal trauma appendicitis ovarian torsion testicular torsion ```
56
Adolescent acute abdo DDx (9)
``` ectopic pregnancy IBD PID pancreatitis cholecystitis appendicitis ovarian torsion testicular torsion abdominal trauma ```
57
Trauma team activation | 10
``` Abnormal vitals for age GCS<9 specific injuries including- spinal flail chest major vascular penetrating/crush/severe blunt to head or torso limb amputation burns>20% BSA or inhaled Multiple body regions ```
58
I-MIST-AMBO handover
``` ID - name, age, weight MOI Injuries/info Signs (inc first, worst, recent) Tx to date Allergies Meds B/G Other - fam contact ```
59
NAI Concerns (5)
Delay in seeking tx despite signif injury Inconsistent hx over time or between caregivers MoI inconsistent with developmental stage caregiver impairment Allegation raised by caregiver/child <12months most common
60
NAI injury patterns (12) Bruise # Bleed
``` bruising (<9months) face/ears/buttocks/back bruising in shape of object/ligature Multiple injuries at different stages of healing or bilateral torn frenulum long bone # (exc toddler #) posterior rib # skull (non-parietal) metaphyseal, bucket handle scapular # sternal # ``` Retinal haemorrhage ICH
61
Paeds airway differences (8)
``` smaller oral cavity larger tongue larger occiput flex forward if flat obligate nasal breather <6months larynx higher +anterior (c2/3) larger epiglottis projects posteriorly cricoid narrowest point susceptible to oedema shorter trachea - ETT dislodgement ```
62
Paeds breathing differences (3)
``` ribs horizontal - limits TV diaphragmatic breathers (need stomach decomp) less type 1 fibres so fatigue quicker higher met rate - increased o2 demand ```
63
``` Circulating blood vols neo infant child adult ```
90ml/kg neo (NN) 80ml/kg infant (EEnfent) 70ml/kg child 65ml/kg adult
64
Paeds circulation differences (6)
``` smaller blood vol overall lower systemic vasc res hypotension/bradycardia late signs U/O 1-2ml/kg/hr fixed SV so need to increase HR to inc CO smaller vessels, hard access ```
65
Peads D + E differences | (4 + 2)
ant font open <18months thinner cranial bones larger head, higher centre of gravity inc head trauma fulcrum c1-2 so higher c-spine injuries larger SA:BM ratio, increased heat loss Inc glucose requirement as lower glycogen stores increased BMR
66
Asthma definition
chronic inflammatory disease of airways characterised by reversible airway obstruction, hyper-responsive airways and bronchospasm
67
What is breath stacking?
Increased autoPEEP due to increased resistance leads to dynamic hyperinflation due to air trapping Unable to expire full breath during expiratory time
68
Asthma DDx (7)
``` ANAPHYLAXIS Inhaled FB pneumonia bronchiolitis congenital - laryngomalacia CF GORD ```
69
Asthma Red Flags (5)
``` previous ICU poor adherence poor control brittle asthma hx anaphylaxis ```
70
Asthma useful exam findings (3 main)
1. WoB - accessory muscle, recession, tug 2. General appearance 3. Mental status nb wheeze intensity, tachycardia after salbutamol, ability to talk, initial 02 less helpful.
71
Asymmetrical lung sounds in ?asthma DDx
Mucus plugging pneumothorax inhaled FB pneumonia
72
INH Salbutamol dose
100mcg/puff via spacer <6 6puffs >6 12 puffs 20mins x3
73
INH Ipratropium dose
21mcg/puff via spacer <6 4 puffs >6 8 puffs 20mins x 3 max 1 hour
74
Asthma steroid doses
PO pred 2mg/kg max 60mg stat then 1mg/kg/day IV methylpred 1mg/kg Q6hr IV hydrocort 4mg/kg max 300mg Q6Hr
75
Asthma MgSO4 dose
MgSO4 50% vial is 10mmol/5ml 1ml=2mmol=500mg dilute to 10mmol/50ml - > 0.2mmol/ml ``` DOSE 0.2mmol/kg over 20 max 8mmol (40kg) ```
76
Asthma 02
If sats persist below 90% | HUMIDIFIED
77
IV salbutamol dose
15mcg/kg/min over 10mins | 1-2mcg/kg/min
78
NIV benefits (7) in asthma
-Improve ventilation (reverse acidosis + hiC02) - Prevent atelectasis, alveolar recruit (inc 02) - Reduced V/Q mistmatch - Reduce dead space - Decrease WoB if PEEP matches intrinsicPEEP ->Reduce fatigue - Pre-oxygenate if prepping for intubation and may avoid need
79
NIV risks in asthma (9)
- Dynamic hyperinflation if external PEEP > intrinsic PEEP - Barotrauma - Air swallowing - abdo distension - Hypotension if hypovolaem - May delay intubation - Aspiration - Pressure ulcers/necrosis - claustrophobia/anxiety - Increased ICP / IOP
80
When to avoid NIV (5)
``` Reduced LoC Agitated Vomiting Profuse secretions Signif haemodynamic instability ```
81
HFNC rate
2l/kg/min humidified with small amount of PEEP Reduce dead space
82
Intubation/IPPV in asthma -things to do (3), drugs to use (3)
1.Cuffed tube 2.Good sedation - Reduce 02 consumption anxiety CO2 production 3.NGTube to decomp ketamine/roc/IVFluid
83
Ventilation aims asthma 3 things to prevent 7 changes to vent
Prevent: 1) Dynamic hyperinflation 2) Barotrauma 3) Haemodynamic comp ``` Low TV Low RR (half rate) Low PEEP (match iPEEP) Plateau pressure <30 Prolong expiratory time I:E >4 Permissive hi-CO2 pH7.25 Change peak pressure alarm to high setting ```
84
Intubation/IPPV Hypotension (6)
``` Tension pneumothorax sedation reducing vascular tone unmasked hypovolaem PPV reduce venous return, reduced preload Dynamic hyperinflation mucus plugging ```
85
Ventilation IPPV asthma acute deterioration - | 6 steps
``` Disconnect Manually decompress Bag - chest sounds/chest rise Needle decompress if tension CXR - ETT location IVF bolus 20ml/kg n.s IV vasopressor 0.05-1mcg/kg/min ```
86
Asthma admission criteria (3) | ICU admission
Mod+ criteria Poor response/unable to wean salbutamol 02 requirement -Respiratory support
87
IV adrenaline infusion preparation
0.6mg/kg (600mcg/kg) in 50ml glucose 10% 1ml/hr = 0.2mcg/kg/min dose 0.05-1mcg/kg/min ``` e.g 10kg child 6mg in 50ml =120mcg/ml -> 0.2mcg/kg/min = 2mcg/min = 120mcg/hr = 1ml/hr ```
88
Asthma discharge criteria 3 clinical 3 safety
Mild - well 1 hour post assessment 02>90% and well adequate oral intake adequate education Observed spacer use action plan GP/paed f/u planned <48hours
89
Bronchiolitis definition
Viral LRTI generally affects <2yrs old
90
Bronchiolitis pathology (4)
oedematous epithelium obstruction atelectasis wheeze
91
Respiratory distress signs
``` nasal flare recession grunting apnoeas blue spells wheeze ```
92
Infant feeding volumes
150ml/kg/day divide into 6-8 feeds 3-4hourly
93
Bronchiolitis b/g red flags (8)
``` chronological age <10weeks chronic lung disease congenital heart disease indigenous immunodeficient trisomy 21 smoked exposed neurological condition ```
94
``` Bronchiolitis Exam features (6) ```
``` resp distress / accessory muscle use behaviour resp rate 02 sats/requirement apnoeas feeding ```
95
Bronchiolitis Mx | 5
minimal handling NGT 2/3 maintenance if <50% intake in 24hrs NP 02 if sats<90% cease once >90 for 2hr IN saline drops to assist with feeding or superficial suction HFNC if failed low flo 2l/kg/min 40% fio2 then titrate down
96
bronchiolitis intubation (3)
1. increased wob/fatigue despite NIV 2. recurrent apnoeas 3. to transport to tertiary
97
Adrenaline side effects / complications (6)
``` tachycardia hypertension n+v hypokalaemia high lactate ischaemia/tissue necrosis if extravasation ```
98
Status epilepticus definition
Seizures lasting >5mins or repeated seizures without full recovery to normal consciousness between episodes
99
Seizure causes - GET METHI neonate version too, different MEI
Glucose - hi, low Electrolytes - Na, Ca, Mg Trauma - head injury, ICH, ``` Med changes /adherence Eclampsia Tox inc TCA, antipsych,antichol, withdrawal Hypoxia /hyperthermia Infections inc encephalitis ``` in neonates - M - metabolic IEM E - environmental I - infantile spasms
100
Seizure DDx
``` Paroxysmal non-epileptic Extensor posturing (ICP) Chorea, Tics Dystonic reactions tetany ```
101
Status Epilepticus Tx
``` 2xbenzo Midazolam 0.15mg/kg IV 0.15-0.2mg/kg IM 0.3mg/kg IN ``` Levetiracetam 40mg/kg max 2.5gram over 5mins Phenytoin 20mg/kg (max1.5gr) rate 1mg/kg/min Phenobarbitone 20mg/kg (max1gr) rate 1mg/kg/min RSI/IPPV propofol 2-3mg/kg ketamine 1-2mg/kg Roc 1.2mg/kg
102
Discharge after seizure (6)
``` Certain of the Dx No further seizure after 4hrs obs Alert and at baseline normal obs caregiver educated and able to return if further seizures f.u organised ```
103
THE MISFITS- the crashing neonate
``` Trauma Heart disease Endocrine Metabolic/ electrolyte iEMetabolism Seizures Formula errors Intestinal catastrophe Tox Sepsis ```
104
Paediatric assessment triangle inc | TICLS
Appearance TICLS - tone, interaction, consolable, look(gaze) , speech (cry) WoB nasal flare, grunt, recession, head bob, tachypnoea Circulation pallor, mottled, blue,, grey
105
Hyperoxia test
100% fio02 for 10mins. If sats <95% or less 10% change then likely cardiac cyanotic heart disease. tx PGE1 0.05-0.1mcg/kg/min
106
Herpes simplex tx
IV acyclovir 20mg/kg 8hourly
107
congenital adrenal hyperplasia signs
``` hyperK hypoNa Hypogly Hypotension Shock refractory to fluid and intotropes ``` ambiguous genitalia clitoromegaly hyperpigmented
108
SVT treatment
adenosine 0.1mg/kg, increase to by 0.1mg/kg up to max of 0.5mg/kg synchronised DC cardioversion 0.5-1j/kg
109
peripheral cyanosis DDX (4)
septic shock cardiogenic shock hypovolaemic shock environmental - hypothermia
110
CVS - causes of crashing neonate
cyanotic heart disease heart failure from myocarditis, arrythmia, sepsis persistent pulmonary hypertension
111
``` cyanotic heart disease 5Ts tet tot tran tri trunc ```
``` R -> L shunt Tetralogy of fallot total anomalous pulmonary venous ret. transposition great arteries tricuspid valve atresia truncus arteriosus ```
112
PDA required for systemic circulation - grey baby | 4
``` cyanosis + poor systemic circulation (all affecting left side) TGA hypoplastic left heart coarc of aorta critical aortic valve steno ```
113
PDA required for pulmonary circulation
Blue baby - systemic perfusion adequate, but cyanosed (right sided) tricuspid atresia ToF critical pulm valve stenosis
114
PGE-1 Dose alprostadil / Prostin SEs (4)
0.05-0.1mcg/kg/min Should see improvement within 30-60mins Reduce dose once able S.Es apnoeas, fever, flushing, cardiovascular collapse
115
Tetralogy of Fallot
``` Cyanotic heart defect 1.VSD 2.Pulmonary stenosis 3.overriding aorta 4,RVH ``` Blue baby as relies on PDA for pulmonary circulation as blood flow directed through VSD into aorta not PAs
116
transposition of great arteries
aorta arises from RV, pulmonary arteries arise from LV. Need a PFO for blood to cross between RA and LA
117
total anomalous pulmonary venous drainage
pulm veins connect to systemic veins so return to RA. Need ASD for blood to flow from RA to LA. Only cyanotic heart defect that will get worse with PGE-1 dilates pulm vasc and increased l>r shunt through PDA
118
Tricuspid atresia
No connection between RA and RV (hypoplastic) | Need VSD for blood to get from LV to RV/lungs
119
Truncus arteriosus
Aorta and PA have single origin. Blood from LV and RV pass across VSD into a single trunk Pulm circ exposed to systemic pressures and flow
120
Infantile spasms
most common severe epilepsy of infants stereotyped clusters of neck/trunk/limb muscle spasms. Brief, bilateral, symmetric assoc. west syndrome, T21, tuberous sclerosis, HIE
121
thyrotoxicosis tx (4)
methamizole 0.25mg/kg PO BD potassium iodide 0.05ml Q8hr after methamizole pred 1mg/kg PO propanolol 0.5-1mg/kg PO BD
122
Inborn errors of metabolism | bloods + tx
``` VBG - AG glucose ammonia lactate ketones EUC LFT FBC/coags may also be deranged ``` 5ml/kg 10% dextrose IV
123
Inborn errors of metabolism blood interpretations
HAGMA - organic acids NAGMA - carb or fat e.g glycogen storage disorder Ammonia - urea cycle disorders Hypoglycaemia+ketonuria = fatty acid oxidation disorder Hypogly w/out ketone = carb metabolism or organic acidaemia
124
SVT treatment
stable - try vagal manoeuvres inc modified valsalva in older children or diving reflex in infants Adenosine 100mcg then increase increments up to 500mcg (no more than 1.2mg) Synchronised DC cardioversion 1j/kg then 2j/kg
125
SVT 5 D's of adenosine failure
``` DELIVERY - too slow DISTANCE - cannula to far from heart DOSE - often 170-200mcg required DRUGS - theophylline interacts DIAGNOSIS - LGL or fascicular VT ```
126
SVT S+S paeds
``` pallor, SoB, poor feeding palpitations chest discomfort ```
127
What drugs to avoid in paeds SVT
B-blocker and verapamil profound AVBlock negative inotropy sudden death
128
Febrile convulsion
Brief isolated generalised tonic clonic seizure that occurred with an acute febrile illness
129
Increased risk of febrile seizure recurrence
1st convulsion <18months fam hx febrile convulsions fam hx epilepsy
130
complex febrile seizure (3)
Duration >15mins (though really >5 as will treat from status) >1 in 24hrs Focal symptoms
131
Discharge criteria febrile convulsion
simple f.convulsion Returned to baseline source of infection can be managed as an OP caregiver education / able to return etc GP f.u arranged within 7 days to evaluate illness
132
Neonatal fever pathogens (6)
``` GBS ecoli listeria HSV salmonella parechovirus ```
133
Neonatal sepsis signs (8)
``` paed assessment triangle marked lethargy inconsolable cry tachypnoea inc. WoB Poor perfusion Persistent tachycardia mod-severe dehydration seizures Parental concern ```
134
Neonatal fever workup (6)
``` BC FBC CRP Urine MCS LP (if no CI) +/- CXR ```
135
29day-3 month work up
``` If typical resp then consider urine MCS (5% of RSV also have UTI) If no clear source Urine MCS FBC CRP BC ```
136
29day-3month discharge criteria
``` Normal urine microscopy neut <10 CRP <20 feeding well no features of SBI ```
137
Features concerning for SBI (7) Similar to toxic features but extras
``` Decreased perfusion pallor >CRT tachycardia Reduced U/O ``` Decreased alertness Rigors Joint swelling
138
CXR criteria in infants
``` cough, tachypnoea, increased WoB sats <93% temp >39 WCC >20 ```
139
Which groups required work up inc BC, FBC, CRP, urinalysis for SBI >3months age group
toxic / septic features immunocompromised petechial rash (worrisome) unimmunised
140
When would you consider urinalysis in >3month old with fever who has no risk factors and immunised?
symptoms of UTI | Fever >48hours and no clear source
141
Discharge criteria >3months with fever
No further Ix or IV tx required No features of SBI Able to hydrate Safe discharge into community
142
Paediatric ECG differences (9)
``` RVH features rightward axis dominant R V1 RSR' V1 juvenile TWI V1-V3 (7days to 7yrs) Inferolateral Qs, narrow ``` ``` sinus arrhythmia, faster rate QTC <490 Shorter intervals (smaller heart) BER - twave is rightward leaning ```
143
Evan's rule for paeds hypertrophy
LVH - V6 R bisects baseline of V5 | RVH - V1 R' larger than R in RSR'
144
Supracondylar # classification
Gartland I-IV I - no displacement, II - displaced with posterior cortex intact III - displaced, multiple planes IV - complete disruption, unstable flex/extension
145
suprcondylar # MoI
Fall on outstretched hand 98% extension type injury, distal fragment posterior 2% flexion type / direct blow to olecranon distal fragment anterior
146
NVI in supracondylar # and how to test (4)
1. AIN A-OK sign 2. Radial n. STOP sign, paper 3. ulnar n. (flexion) scissors, finger abduction Brachial artery
147
Supracondylar # humeral xray findings (6)
``` posterior fat pad anterior sail sign displaced anterior humeral line altered baumanns angle >5% compared to other exclude radial # ```
148
Supracondylar # urgent ortho review
``` signs of NVI brachialis sign risk of compartment syndrome floating elbow Open injury unable to reduce in ED ```
149
long term complications supracondylar # (4)
volkmann's ischaemic contracture (finger flexion, pronated wrist) cubitus varus deformity myositis ossificans nerve injury (AIN / radial / ulnar)
150
AIN injury test
A-OK sign unable to flex thumb IPJ (FDP) index finger DIPJ (FPL)
151
Elbow xray interpretations steps (7)
1. true lateral hour glass 2. fat pads inc sail sign 3. Anterior humeral line 4. radiocapitellar line 5. Baumanns angle 6. cortices 7. CRITOE
152
CRITOE
``` capitellum radial head internal (medial epicondyle) trochlea olecranon external (lateral epicondyle) 1-3-5-7-9-11 easiest, girls before boys ```
153
Upper limb nerve test - rock paper scissors
Rock - median n. finger flexion Paper - radial n. wrist and MCPJ extension Scissors - ulnar n. finger abduction, small muscles of the hand
154
Where to test sensation in the hand
ulnar n - ulnar border of little finger median n - tip of middle finger radial - snuff box
155
lateral condyle # MOI and mx
fall on outstretched arm with varus stress | refer all to ortho as potential for poor outcome
156
medial epicondyle # MOI and MX
avulsion of the attachment of common flexors of the forearm. valgus stress with contraction of forearm flexors operative if >15mm displaced, elbow dislocation with medial epicondyle incarceration n.b exclude medial condyle # which is intra-articular
157
Monteggia fracture dislocation occurence classification most common
MUF - ulnar fracture, radial head dislocation (radioulnar joint) 1% upper limb fractures Bado classification, most anterior dislocation of radial head and ulna shaft fracture (type 1)
158
monteggia fracture dislocation complications
radial nerve and posterior interosseus nerve neuropraxia paper STOP thumbs up n.b wrist extension may have some sparing in PIN
159
monteggia xray assessment lines
radio capitellar line - should pass through centre of capitellum posterior border of ulna line- should be straight, bowing suggests plastic deformity
160
syncope definition
brief LoC associated with loss of postural tone and spontaneous recovery
161
Syncope classification (ROC)
Reflex (neurocardiogenic) Orthostatic Cardiac
162
Syncope red flags (7)
``` No prodrome During exercise Whilst supine Palpitations Chest pain Cardiac hx fam hx sudden death ```
163
Syncope DDx (3s)
Seizure Stroke Sugar (hypoglycaemia)
164
Syncope Ix (6)
``` LSBP ECG BSL if soon after FBC - anaemia HCG - ectopic Lactate - seizure ```
165
cardiac syncope tachy brady structural
``` WPW Brugada Long QT Short QT CPVT ``` complete HB - myocarditis, endocarditis, RF HOCM ARVC Critical AS
166
HOCM | info
No.1 cause sudden cardiac death in children 1/500 LVOT obstruction arrhythmogenic chaotic architecture aberrant coronary arteries
167
HOCM ECG
LVH precordial hi voltage non-specific ST and T wave changes dagger like qs inferolateral Apical HOCM precordial deep TWI
168
ARVD ECG
``` Epsilon wave TWI V1-3 QRS widening V1-3 PVCs VT with LBBB morphology as RVOT tachy ```
169
WPW info
pre-excitation syndrome accessory pathway - bundle of kent valsalva or AVBlockers make pre-excitation more pronounced AVRT or AF
170
WPW ECG
short PR 120ms broad QRS with slurred delta wave -ve delta in aVL = pseudoinfarct pattern dominant R in V1-3 type a TWI V1-3 sim to RVH pattern
171
Brugada info
Auto D sodium channelopathy ecg findings unmasked with fever / ischaemia / drugs hypok treat ICD or quinine in neonate
172
Brugada diagnosis criteria (6)
``` VF/VT Inducible VT Syncope fam hx SCD Noctural agonal resps fam members with coved type ECG ```
173
brugada ECG
1) coved type = coved STE in >1 of V1-V3 follwed by TWI 2) saddleback >2mm STE in V1-V3 3) either patter with <2mm STE
174
Measles rash
``` Morbiliform erythematous Macpap start at hairline and spread inferiorly 2-3 days after onset sxs ```
175
Measles sxs (7)
``` High fever Cough Coryza Conjunctivitis (non-exu) Morbilliform rash Koplik spots +/- forcheimer spots ```
176
Scarlet fever (GAS) sxs (7)
``` High fever Exudative pharyngitis Cervical lymphadenopathy Strawberry tongue (after white coating peels off) abdo pain headache Erythematous rash with circumoral pallor ```
177
Scarlet Fever Rash (7)
``` 1-2 days post sx onset scarletiniform - generalised erythema with tiny papules sandpaper texture circumoral pallor pastia's lines desquamation fingers/toes ```
178
Suppurative complications of GAS
``` OM -> mastoiditis sinusitis peritonsillar abscess retropharyngeal abscess meningitis bacteraemia ```
179
Non-suppurative complications of GAS
``` ARFever -> RHD PSGN TSS Scarlet fever Guttate psoriasis PANDAS ```
180
Rubella rash
``` Rose pink Macpap spreads inferiorly (less widespread than measles) skin may flake after congatious 7days pre- 7 days post rash ```
181
Erythema infectiosum 'Slapped cheek' cause & rash
``` Parvovirus B19 5th disease Erythematous cheeks lacy recticular rash on extremities -ve aplastic crisis ```
182
Roseola Infantum cause
``` HHV6 + 7 Rose pink mac pap Trunk -> neck -> limbs surrounding white halos Appears AFTER fever ```
183
Roseola sxs
``` High fever - risk febrile convulsion URTI lymphaednopathy eyelid oedema nagayama spots on soft palate ```
184
Pityriasis rosea rash
HHV6 / 7 herald patch on trunk prior to rest of rash spreading. Scaly patches / plaques Christmas tree pattern follows langer lines
185
Kawasaki criteria | mucocutaenous lymph node syndrome
high fever >=5 days + 4/5 of 1) Bilateral non-ex conjunctival injection with peri-limbic sparing 2) oropharyngeal mucus membrane changes inc strawberry tongue, cracked red lips, pharyngeal erythema 3)cervical lymphadenopathy 1 node >1.5cm 4. Extremity swelling (periungal desquamation 2 weeks later) 5. generalised polymorphorous rash
186
Kawasaki disease tx
IVIG 2g/kg over 10hours Can rpt if fever persists (CAA reduced from 20% to <5%) aspirin 3-5mg/kg PO 6-8 weeks
187
Stevens-Johnson Syndrome & TENS causes
Type 4 hypersensitivity reaction to drugs or infection or idiopathic (50%) sulfa containing abx, pencillins, anticonvulsants eg sodium valproate NSAID, allopurinol CMV, EBV, coxsackie, mycyplasma, HIV. 50% recent URTI
188
SJS rash
``` <10% BSA skin detachment targetoid (like EM) diffuse erythema macular purpuric nikolsky +Ve start on trunk, extend out ```
189
TEN risk and mortality
HIV (100 fold) TBI, SLE, any immunocomp | >30% BSA skin detachment
190
staph scolded skin syndrome - | dermatitis exfoliative neonatorum
scarlatiniform erythema, +ve nikolsky sign bulla | No MM involvement
191
erythema multiforme causes and rash
causes similar to SJS/TEN though separate entity HSV, mycoplasma, sulfa drugs, abx, anticonvulsants Target lesions spread centripedally Minor- pruritic, no MM Major - non-pruritic, MM involvement, palms soles extensors
192
Lyme disease - tick borne borrelia burgdorferi rash
erythema migrans - large annular /target or bullseye. | dark border, central clearing
193
``` Bronchiolitis assessment criteria Bronchiolitis Originates With Feeling Awful ```
``` Behaviour O2 sats WoB Feeding Apnoeas ```

Acem fellowship (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions