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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

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2
Q

Toxic shock syndrome

A

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

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3
Q

High risk factors for sepsis

A 
<2months
premature
unimmunised
immune def/supp
asplenic
indwelling lines
malignancy (neutropenic)
recent surgery
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4
Q

Sepsis abx <2months

A

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

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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

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6
Q

Septic shock PICU criteria

A 
fluid non-responder 40ml/kg
inotropes 
reduced LoC
hypotension
coagulopathy/DIC
lactate>4
toxic shock
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7
Q

Blood culture volumes

A

neonatal aerobic 1ml+

standard bottles 4ml+

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8
Q

Targets for fluid resus

A

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

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9
Q

TSS abx

A

cefotaxime 50mg/kg

lincomycin 15mg/kg (max 1.2gram)

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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

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11
Q

Calcium gluconate doses

A

Calcium gluconate 10% in 10ml

0.5ml/kg = 0.11mmol/kg

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12
Q

IV hydrocortisone dose

A

1mg/kg if known adrenal insufficiency or intotrope resistant

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13
Q

Septic shock DDx

A 
Anaphylaxis
cardiogenic shock inc congential cardiac, duct dependent lesions 
obstructive shock 
neurogenic shock 
hypovolaemic shock 
congential metabolic disorder
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14
Q

warm shock

A 
vasoplegic
wide pulse pressure
flash CRT
tachycardia
bounding pulse
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15
Q

cold shock

A 
vasoconstricted
narrow PP
tachycardic
slow CRT
tend to be younger
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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
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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

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18
Q

Sepsis signs

A 
fever
hypothermia
AMS (lethargy or agitated) 
abnormal HR, RR, CRT
petechia / purpura / widespread erythema
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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%
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20
Q

NETS referral - Airway

A

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

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21
Q

NETs referral GI

A 
button battery 
FB - vomiting, secretions, drooling, unable to eat
acute GIB
insussception+shock
surgical abdo
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22
Q

NETS referral Resp

A 
Despite max tx
hypoxia
apnoeic events 
resp support required
severe distress
congenital heart/lung dx
mediastinal mass
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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)
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24
Q

NETS referral cardiac

A 
congenital disease + 
resp distress
poor perfusion
arrhythmia
Altered LoC
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25
Q

NETS referral endocrine

A

DKA +
<5 yr
pH <7.15 after 2 hours
severe headache / altered LoC

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26
Q

NETs referral systemic

A

septic shock / TSS
anaphylaxis with ongoing sxs despite tx
pain OOP to clinical exam findings

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27
Q

Non-pharma pain Mx

A 
Immobilise
RICE
Dressings 
distract toy/bubbles/phone 
Swaddle 
Skin to skin 
Feeding / dummy
Breathing techniques
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28
Q

Sucrose dose

A

PO 0.1-0.5ml 2mins pre-procedure
max 5ml/day <3month
max 10ml/day >3month

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29
Q

Paracetamol dose

A

PO 15mg/kg/day IBW
4-6hourly (IV Q6H)
Max 90mg/kg/day >1month

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30
Q

Ibuprofen dose

A

PO 10mg/kg/day 6-8hourly
max 30mg/kg/day
2.4gram max

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31
Q

Fentanyl dose

A

IN 0.75-1.5mcg/kg
Max 75mcg Q10min
Divide between nostrils

IV 0.5-1mcg/kg Q5-10min

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32
Q

Oxycodone dose

A

PO >12months
0.1-0.2mg/kg Q4hr
max 5-10mg dose

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33
Q

Morphine dose

A

IV up to 0/05-0.2mg/kg

max 5-10mg 2-4hourly

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34
Q

Moderate dehydration (5-9%) signs

A 
tachy
lethargy
tachypnoea
sunken eyes 
dry MM
decreased skin turgor
CRT >2
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35
Q

Severe dehydration -(>=10%) Shock

A 
Reduced LoC
Tachy
Tachypnoea / kussmaul
hypotensive 
pale/mottled
cold
weak pulse 
decreased skin turgor 
CRT >2++
Deeply sunken eyes
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36
Q

IVF bolus

A

0.9% NaCl
10-20ml/kg
max 40ml/kg then likely need inotropes

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37
Q

IVfluid maintenance calc

A

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
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38
Q

Seizure Tx

A

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

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39
Q

Hyperkalaemia Tx

(5 drugs)

A
  • 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
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40
Q

Hypertonic saline dose

A

3% NaCl 3ml/kg over 10mins large vein

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41
Q

Intubation medication

A

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

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42
Q

Mag sulfate dose

A

0.2mmol/kg over 20mins if pulse present

10mmol/5ml

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43
Q

APLS Intervention (4)

A

15:2 compression/vent
Adrenaline 10mcg/kg
Defib 4j/kg
Amiodarone 5mg/kg after 3rd shock if shockable

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44
Q

Weight estimate

A

(age+4)x2

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45
Q

ETT tube sizing

A

Age/4 + 3.5 for cuffed

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46
Q

Glucose dose

A

10% dextrose 2ml/kg

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47
Q

BP normal estimate

A

Agex2 +65mmHg

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48
Q

ETT tube depth estimate

A

> 1yr Age/2+13

<1yr weight/2 +8

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49
Q 
Vital normal ranges 
Simplified
0-6month
6-12month
1-4years
A

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

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50
Q

Unsettled baby red flags (3)

A

sudden onset irritability/cry
Parental PND
NAI risks as sign of abusive head trauma

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51
Q

Unsettled baby DDx (8)

A 
NAInjury
incarcerated inguinal hernia / torsion
sepsis / infection
hair tourniqet
corneal abrasion??
Raised ICP
Non-IGe cows milk allergy
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52
Q

Acute abdo pain

Non-abdominal causes (9)

A 
DKA
HSP
Pneumonia 
Hip pathology
UTI/pyelo
testicular torsion
sepsis
sickle cell VOcrisis
toxins/OD
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53
Q

Acute abdo pain Ix

A 
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

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54
Q

Neonatal acute abdomen

DDx (5)

A 
hirschsprung enterocolitis
Nec enterocolitis 
incarcerated hernia
volvulus 
intersussception
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55
Q

Infant/child Acute Abdo DDx (9)

A 
pyloric stenosis 
meckel's diverticulum
incarcerated hernia
volvulus 
intersussception 
abdominal trauma 
appendicitis 
ovarian torsion 
testicular torsion
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56
Q

Adolescent acute abdo DDx (9)

A 
ectopic pregnancy 
IBD
PID
pancreatitis 
cholecystitis 
appendicitis 
ovarian torsion
testicular torsion
abdominal trauma
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57
Q

Trauma team activation

10

A 
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
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58
Q

I-MIST-AMBO handover

A 
ID - name, age, weight
MOI
Injuries/info 
Signs (inc first, worst, recent)
Tx to date 
Allergies
Meds
B/G
Other - fam contact
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59
Q

NAI Concerns (5)

A

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

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60
Q

NAI injury patterns (12)
Bruise
#
Bleed

A 
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

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61
Q

Paeds airway differences (8)

A 
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
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62
Q

Paeds breathing differences (3)

A 
ribs horizontal - limits TV
diaphragmatic breathers
(need stomach decomp)
less type 1 fibres so fatigue quicker
higher met rate - increased o2 demand
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63
Q 
Circulating blood vols
neo
infant
child 
adult
A

90ml/kg neo (NN)
80ml/kg infant (EEnfent)
70ml/kg child
65ml/kg adult

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64
Q

Paeds circulation differences (6)

A 
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
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65
Q

Peads D + E differences

(4 + 2)

A

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

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66
Q

Asthma definition

A

chronic inflammatory disease of airways characterised by reversible airway obstruction, hyper-responsive airways and bronchospasm

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67
Q

What is breath stacking?

A

Increased autoPEEP due to increased resistance leads to dynamic hyperinflation due to air trapping
Unable to expire full breath during expiratory time

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68
Q

Asthma DDx (7)

A 
ANAPHYLAXIS
Inhaled FB
pneumonia
bronchiolitis 
congenital - laryngomalacia
CF
GORD
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69
Q

Asthma Red Flags (5)

A 
previous ICU 
poor adherence 
poor control
brittle asthma 
hx anaphylaxis
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70
Q

Asthma useful exam findings (3 main)

A
  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.

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71
Q

Asymmetrical lung sounds in ?asthma DDx

A

Mucus plugging
pneumothorax
inhaled FB
pneumonia

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72
Q

INH Salbutamol dose

A

100mcg/puff via spacer
<6 6puffs
>6 12 puffs
20mins x3

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73
Q

INH Ipratropium dose

A

21mcg/puff via spacer
<6 4 puffs
>6 8 puffs
20mins x 3 max 1 hour

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74
Q

Asthma steroid doses

A

PO pred 2mg/kg max 60mg stat then 1mg/kg/day

IV methylpred 1mg/kg Q6hr

IV hydrocort 4mg/kg max 300mg Q6Hr

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75
Q

Asthma MgSO4 dose

A

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)
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76
Q

Asthma 02

A

If sats persist below 90%

HUMIDIFIED

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77
Q

IV salbutamol dose

A

15mcg/kg/min over 10mins

1-2mcg/kg/min

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78
Q

NIV benefits (7) in asthma

A

-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
Q

NIV risks in asthma (9)

A
  • 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
Q

When to avoid NIV (5)

A 
Reduced LoC
Agitated
Vomiting 
Profuse secretions
Signif haemodynamic instability
81
Q

HFNC rate

A

2l/kg/min
humidified with small amount of PEEP
Reduce dead space

82
Q

Intubation/IPPV in asthma -things to do (3), drugs to use (3)

A

1.Cuffed tube
2.Good sedation - Reduce 02 consumption
anxiety
CO2 production
3.NGTube to decomp
ketamine/roc/IVFluid

83
Q

Ventilation aims asthma
3 things to prevent
7 changes to vent

A

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
Q

Intubation/IPPV Hypotension (6)

A 
Tension pneumothorax
sedation reducing vascular tone
unmasked hypovolaem
PPV reduce venous return, reduced preload
Dynamic hyperinflation
mucus plugging
85
Q

Ventilation IPPV asthma acute deterioration -

6 steps

A 
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
Q

Asthma admission criteria (3)

ICU admission

A

Mod+ criteria
Poor response/unable to wean salbutamol
02 requirement
-Respiratory support

87
Q

IV adrenaline infusion preparation

A

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
Q

Asthma discharge criteria
3 clinical
3 safety

A

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
Q

Bronchiolitis definition

A

Viral LRTI generally affects <2yrs old

90
Q

Bronchiolitis pathology (4)

A

oedematous epithelium
obstruction
atelectasis
wheeze

91
Q

Respiratory distress signs

A 
nasal flare
recession
grunting 
apnoeas
blue spells 
wheeze
92
Q

Infant feeding volumes

A

150ml/kg/day
divide into 6-8 feeds
3-4hourly

93
Q

Bronchiolitis b/g red flags (8)

A 
chronological age <10weeks
chronic lung disease
congenital heart disease
indigenous
immunodeficient
trisomy 21
smoked exposed
neurological condition
94
Q 
Bronchiolitis 
Exam features (6)
A 
resp distress / accessory muscle use 
behaviour
resp rate
02 sats/requirement
apnoeas
feeding
95
Q

Bronchiolitis Mx

5

A

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
Q

bronchiolitis intubation (3)

A
  1. increased wob/fatigue despite NIV
  2. recurrent apnoeas
  3. to transport to tertiary
97
Q

Adrenaline side effects / complications (6)

A 
tachycardia 
hypertension 
n+v
hypokalaemia 
high lactate 
ischaemia/tissue necrosis  if extravasation
98
Q

Status epilepticus definition

A

Seizures lasting >5mins or repeated seizures without full recovery to normal consciousness between episodes

99
Q

Seizure causes -
GET METHI
neonate version too, different MEI

A

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
Q

Seizure DDx

A 
Paroxysmal non-epileptic
Extensor posturing (ICP)
Chorea, Tics
Dystonic reactions 
tetany
101
Q

Status Epilepticus Tx

A 
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
Q

Discharge after seizure (6)

A 
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
Q

THE MISFITS- the crashing neonate

A 
Trauma
Heart disease
Endocrine
Metabolic/ electrolyte
iEMetabolism
Seizures 
Formula errors
Intestinal catastrophe
Tox
Sepsis
104
Q

Paediatric assessment triangle inc

TICLS

A

Appearance
TICLS -
tone,
interaction, consolable, look(gaze) , speech (cry)

WoB
nasal flare, grunt, recession, head bob, tachypnoea

Circulation
pallor, mottled, blue,, grey

105
Q

Hyperoxia test

A

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
Q

Herpes simplex tx

A

IV acyclovir 20mg/kg 8hourly

107
Q

congenital adrenal hyperplasia signs

A 
hyperK
hypoNa
Hypogly
Hypotension 
Shock refractory to fluid and intotropes

ambiguous genitalia
clitoromegaly
hyperpigmented

108
Q

SVT treatment

A

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
Q

peripheral cyanosis DDX (4)

A

septic shock
cardiogenic shock
hypovolaemic shock
environmental - hypothermia

110
Q

CVS - causes of crashing neonate

A

cyanotic heart disease
heart failure from myocarditis, arrythmia, sepsis
persistent pulmonary hypertension

111
Q 
cyanotic heart disease 5Ts
tet 
tot
tran
tri
trunc
A 
R -> L shunt
Tetralogy of fallot
total anomalous pulmonary venous ret.
transposition great arteries
tricuspid valve atresia
truncus arteriosus
112
Q

PDA required for systemic circulation - grey baby

4

A 
cyanosis + poor systemic circulation (all affecting left side)
TGA
hypoplastic left heart
coarc of aorta
critical aortic valve steno
113
Q

PDA required for pulmonary circulation

A

Blue baby - systemic perfusion adequate, but cyanosed (right sided)
tricuspid atresia
ToF
critical pulm valve stenosis

114
Q

PGE-1 Dose
alprostadil / Prostin

SEs (4)

A

0.05-0.1mcg/kg/min
Should see improvement within 30-60mins
Reduce dose once able
S.Es apnoeas, fever, flushing, cardiovascular collapse

115
Q

Tetralogy of Fallot

A 
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
Q

transposition of great arteries

A

aorta arises from RV, pulmonary arteries arise from LV. Need a PFO for blood to cross between RA and LA

117
Q

total anomalous pulmonary venous drainage

A

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
Q

Tricuspid atresia

A

No connection between RA and RV (hypoplastic)

Need VSD for blood to get from LV to RV/lungs

119
Q

Truncus arteriosus

A

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
Q

Infantile spasms

A

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
Q

thyrotoxicosis tx (4)

A

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
Q

Inborn errors of metabolism

bloods + tx

A 
VBG - AG
glucose
ammonia
lactate
ketones
EUC
LFT
FBC/coags may also be deranged

5ml/kg 10% dextrose IV

123
Q

Inborn errors of metabolism blood interpretations

A

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
Q

SVT treatment

A

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
Q

SVT 5 D’s of adenosine failure

A 
DELIVERY - too slow
DISTANCE - cannula to far from heart 
DOSE - often 170-200mcg required
DRUGS - theophylline interacts 
DIAGNOSIS - LGL or fascicular VT
126
Q

SVT S+S paeds

A 
pallor, 
SoB, 
poor feeding
palpitations 
chest discomfort
127
Q

What drugs to avoid in paeds SVT

A

B-blocker and verapamil
profound AVBlock
negative inotropy
sudden death

128
Q

Febrile convulsion

A

Brief isolated generalised tonic clonic seizure that occurred with an acute febrile illness

129
Q

Increased risk of febrile seizure recurrence

A

1st convulsion <18months
fam hx febrile convulsions
fam hx epilepsy

130
Q

complex febrile seizure (3)

A

Duration >15mins (though really >5 as will treat from status)
>1 in 24hrs
Focal symptoms

131
Q

Discharge criteria febrile convulsion

A

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
Q

Neonatal fever pathogens (6)

A 
GBS
ecoli
listeria
HSV
salmonella
parechovirus
133
Q

Neonatal sepsis signs (8)

A 
paed assessment triangle
marked lethargy
inconsolable cry
tachypnoea inc. WoB
Poor perfusion
Persistent tachycardia
mod-severe dehydration 
seizures
Parental concern
134
Q

Neonatal fever workup (6)

A 
BC
FBC
CRP
Urine MCS
LP (if no CI)
\+/- CXR
135
Q

29day-3 month work up

A 
If typical resp then consider urine MCS (5% of RSV also have UTI)
If no clear source 
Urine MCS
FBC
CRP
BC
136
Q

29day-3month discharge criteria

A 
Normal urine microscopy
neut <10
CRP <20 
feeding well
no features of SBI
137
Q

Features concerning for SBI (7) Similar to toxic features but extras

A 
Decreased perfusion
pallor
>CRT
tachycardia
Reduced U/O

Decreased alertness

Rigors

Joint swelling

138
Q

CXR criteria in infants

A 
cough, 
tachypnoea, 
increased WoB
sats <93%
temp >39
WCC >20
139
Q

Which groups required work up inc BC, FBC, CRP, urinalysis for SBI >3months age group

A

toxic / septic features
immunocompromised
petechial rash (worrisome)
unimmunised

140
Q

When would you consider urinalysis in >3month old with fever who has no risk factors and immunised?

A

symptoms of UTI

Fever >48hours and no clear source

141
Q

Discharge criteria >3months with fever

A

No further Ix or IV tx required
No features of SBI
Able to hydrate
Safe discharge into community

142
Q

Paediatric ECG differences (9)

A 
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
Q

Evan’s rule for paeds hypertrophy

A

LVH - V6 R bisects baseline of V5

RVH - V1 R’ larger than R in RSR’

144
Q

Supracondylar # classification

A

Gartland I-IV
I - no displacement,
II - displaced with posterior cortex intact
III - displaced, multiple planes
IV - complete disruption, unstable flex/extension

145
Q

suprcondylar # MoI

A

Fall on outstretched hand
98% extension type injury, distal fragment posterior
2% flexion type / direct blow to olecranon
distal fragment anterior

146
Q

NVI in supracondylar # and how to test (4)

A
  1. AIN A-OK sign
  2. Radial n. STOP sign, paper
  3. ulnar n. (flexion) scissors, finger abduction
    Brachial artery
147
Q

Supracondylar # humeral xray findings (6)

A 
posterior fat pad
anterior sail sign 
displaced anterior humeral line 
altered baumanns angle >5% compared to other
exclude radial #
148
Q

Supracondylar # urgent ortho review

A 
signs of NVI
brachialis sign
risk of compartment syndrome
floating elbow
Open injury 
unable to reduce in ED
149
Q

long term complications supracondylar # (4)

A

volkmann’s ischaemic contracture (finger flexion, pronated wrist)
cubitus varus deformity
myositis ossificans
nerve injury (AIN / radial / ulnar)

150
Q

AIN injury test

A

A-OK sign
unable to flex
thumb IPJ (FDP)
index finger DIPJ (FPL)

151
Q

Elbow xray interpretations steps (7)

A
  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
Q

CRITOE

A 
capitellum
radial head 
internal (medial epicondyle)
trochlea
olecranon
external (lateral epicondyle) 
1-3-5-7-9-11 easiest, girls before boys
153
Q

Upper limb nerve test - rock paper scissors

A

Rock - median n. finger flexion
Paper - radial n. wrist and MCPJ extension
Scissors - ulnar n. finger abduction, small muscles of the hand

154
Q

Where to test sensation in the hand

A

ulnar n - ulnar border of little finger
median n - tip of middle finger
radial - snuff box

155
Q

lateral condyle # MOI and mx

A

fall on outstretched arm with varus stress

refer all to ortho as potential for poor outcome

156
Q

medial epicondyle # MOI and MX

A

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
Q

Monteggia fracture dislocation
occurence
classification
most common

A

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
Q

monteggia fracture dislocation complications

A

radial nerve and posterior interosseus nerve neuropraxia
paper
STOP
thumbs up
n.b wrist extension may have some sparing in PIN

159
Q

monteggia xray assessment lines

A

radio capitellar line - should pass through centre of capitellum
posterior border of ulna line- should be straight, bowing suggests plastic deformity

160
Q

syncope definition

A

brief LoC associated with loss of postural tone and spontaneous recovery

161
Q

Syncope classification (ROC)

A

Reflex (neurocardiogenic)
Orthostatic
Cardiac

162
Q

Syncope red flags (7)

A 
No prodrome
During exercise 
Whilst supine 
Palpitations 
Chest pain 
Cardiac hx 
fam hx sudden death
163
Q

Syncope DDx (3s)

A

Seizure
Stroke
Sugar (hypoglycaemia)

164
Q

Syncope Ix (6)

A 
LSBP
ECG
BSL if soon after 
FBC - anaemia
HCG - ectopic
Lactate - seizure
165
Q

cardiac syncope
tachy
brady
structural

A 
WPW
Brugada
Long QT
Short QT
CPVT

complete HB - myocarditis, endocarditis, RF

HOCM
ARVC
Critical AS

166
Q

HOCM

info

A

No.1 cause sudden cardiac death in children 1/500
LVOT obstruction
arrhythmogenic chaotic architecture
aberrant coronary arteries

167
Q

HOCM ECG

A

LVH precordial hi voltage
non-specific ST and T wave changes
dagger like qs inferolateral

Apical HOCM precordial deep TWI

168
Q

ARVD ECG

A 
Epsilon wave
TWI V1-3
QRS widening V1-3
PVCs
VT with LBBB morphology as RVOT tachy
169
Q

WPW info

A

pre-excitation syndrome
accessory pathway - bundle of kent
valsalva or AVBlockers make pre-excitation more pronounced
AVRT or AF

170
Q

WPW ECG

A

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
Q

Brugada info

A

Auto D sodium channelopathy
ecg findings unmasked with fever / ischaemia / drugs
hypok
treat ICD or quinine in neonate

172
Q

Brugada diagnosis criteria (6)

A 
VF/VT
Inducible VT
Syncope 
fam hx SCD
Noctural agonal resps
fam members with coved type ECG
173
Q

brugada ECG

A

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
Q

Measles rash

A 
Morbiliform
erythematous
Macpap
start at hairline and spread inferiorly
2-3 days after onset sxs
175
Q

Measles sxs (7)

A 
High fever
Cough 
Coryza
Conjunctivitis (non-exu)
Morbilliform rash
Koplik spots
\+/- forcheimer spots
176
Q

Scarlet fever (GAS) sxs (7)

A 
High fever
Exudative pharyngitis
Cervical lymphadenopathy
Strawberry tongue (after white coating peels off)
abdo pain 
headache
Erythematous rash with circumoral pallor
177
Q

Scarlet Fever Rash (7)

A 
1-2 days post sx onset
scarletiniform - generalised erythema with tiny papules
sandpaper texture
circumoral pallor
pastia's lines 
desquamation fingers/toes
178
Q

Suppurative complications of GAS

A 
OM -> mastoiditis 
sinusitis 
peritonsillar abscess
retropharyngeal abscess
meningitis 
bacteraemia
179
Q

Non-suppurative complications of GAS

A 
ARFever -> RHD
PSGN
TSS
Scarlet fever
Guttate psoriasis 
PANDAS
180
Q

Rubella rash

A 
Rose pink
Macpap
spreads inferiorly (less widespread than measles)
skin may flake after
congatious 7days pre- 7 days post rash
181
Q

Erythema infectiosum
‘Slapped cheek’
cause & rash

A 
Parvovirus B19
5th disease
Erythematous cheeks
lacy recticular rash on extremities 
-ve aplastic crisis
182
Q

Roseola Infantum cause

A 
HHV6 + 7 
Rose pink mac pap
Trunk -> neck -> limbs
surrounding white halos
Appears AFTER fever
183
Q

Roseola sxs

A 
High fever - risk febrile convulsion
URTI
lymphaednopathy
eyelid oedema
nagayama spots on soft palate
184
Q

Pityriasis rosea rash

A

HHV6 / 7
herald patch on trunk prior to rest of rash spreading.
Scaly patches / plaques
Christmas tree pattern follows langer lines

185
Q

Kawasaki criteria

mucocutaenous lymph node syndrome

A

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
Q

Kawasaki disease tx

A

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
Q

Stevens-Johnson Syndrome & TENS causes

A

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
Q

SJS rash

A 
<10% BSA  skin detachment
targetoid (like EM) 
diffuse erythema
macular
purpuric
nikolsky +Ve
start on trunk, extend out
189
Q

TEN risk and mortality

A

HIV (100 fold) TBI, SLE, any immunocomp

>30% BSA skin detachment

190
Q

staph scolded skin syndrome -

dermatitis exfoliative neonatorum

A

scarlatiniform erythema, +ve nikolsky sign bulla

No MM involvement

191
Q

erythema multiforme causes and rash

A

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
Q

Lyme disease - tick borne borrelia burgdorferi rash

A

erythema migrans - large annular /target or bullseye.

dark border, central clearing

193
Q 
Bronchiolitis 
assessment criteria 
Bronchiolitis 
Originates
With 
Feeling 
Awful
A 
Behaviour
O2 sats 
WoB
Feeding 
Apnoeas

Acem fellowship (1 decks)

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