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3a > Paediatrics: A-E > Flashcards

Paediatrics: A-E Flashcards

1
Q

what is the 3 minute toolkit?

A

top to toe examination and physiology assessment

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2
Q

what does ABCDENTTT, DEFG stand for?

A
  • Airways
  • Breathing
  • Circulation
  • Disability (neuro)
  • Ears, nose + throat examination
  • Temperature
  • Tummy

DEFG (don’t ever forget glucose)

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3
Q

3 minute toolkit overview: what do you look for for A

A

airway
- secretions
- stridor
- foreign body

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4
Q

3 minute toolkit overview: What do you look for for B

A

breathing (effort, efficacy, effect)
- RR
- Recession/accessory muscle use
- Oxygen saturation
- Auscaltation

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5
Q

3 minute toolkit overview: what do you look for for C?

A

Circulation
- Colour (e.g. pale, mottled)
- HR
- Cap Refill
- Temperature of hand and feet

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6
Q

3 minute toolkit overview: What do you look for for D?

A

Disability (neuro)
- Pupils
- Limb tone + movement
- AVPU score/GCS

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7
Q

airway assessment: child has reduced consciousness levels, why test gag reflex? what do you do?

A

oropharyngeal airway: if tolerated => child not protecting airway => jaw thrust + call anaesthetist

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8
Q

do children look better or worse than adults when hypoxic?

A

better
- children can be close to decompoenstaion when looking well

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9
Q

what oxy sats should ac child have

A

> 96%

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10
Q

oxy sats significant hypoxia ? worrying hypoxia?

A

sig: <94%
worrying: < 90%

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11
Q

at what oxy sats might a child start showing signs of cyanosis?

A

<85%
very late!

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12
Q

what does mottling of the skin suggest?

A

poor perfusion

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13
Q

what pulse should you use to get pulse rate?

A

radial pulse
(brachial in baby)
(can use pulse oximeter)

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14
Q

what is normal cap refill time?

A

<2 sec

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15
Q

where do you test cap refill?

A
  • Central (sternum)
  • Peripheral (fingers, toes, hands, feet)
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16
Q

what could cool peripheries suggest?

A

peripheral vasoconstriction due to sepsis, dehydrations

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17
Q

When should you measure BP of a child?

A

only measure if concerned
(drowsy or sick child)
(do it at the end of examination)

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18
Q

When might you get sluggish pupil responses?

A
  • post fit
  • drug overdose
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19
Q

When might you get assymetrical pupil responses?

A

space occupying lesion (extra/subdural haemorrhage)

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20
Q

When might a child be drowsy?

A
  • Post fit
  • High temp
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21
Q

When should you do the ENT assessment

A

leave till the end

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22
Q

How do you position patient to do ears bit of ENT?

A

sit child sideways on parent lap and hold tight, hold baby arms and head still

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23
Q

How to you position patient to do throat bit of ENT?

A

sit baby facing you on parent lap, hold baby arms and head still

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24
Q

Where do you measure temperature ?

A

timpanic (usually better)
axillary strip (recommended in babies)

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25
Q

How should child be positioned for tummy assessment?

A

best lying flat on bed but can do on parent lap

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26
Q

What do you also have do check in boys for tummy assessment? why?

A

check for testicular tosion
- can cause abdo pain

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27
Q

what could cause hypoglycaemia in children?

A
  • recent low calorie intake
  • alcohol consumption
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28
Q

What is one of most common causes for young children to go to doctor?

A

difficulty in breathing

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29
Q

what infections most commonly cause difficulty in breathing?

A
  • strep. Pneumonia
  • haemophluis influenza
  • pertussis
  • Mycoplasma
  • Influenza virus
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30
Q

commonest causes of brethlessness (4)

A
  • Asthma
  • bronchiolitis
  • Pneumonia
  • croup
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31
Q

What main symptoms does asthma cause?

A
  • Breathlessness
  • Coughing
  • Wheezing
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32
Q

asthma pathophysiology?

A

hyperactive airways => constrict + secret mucus => narrow airways => wheezing

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33
Q

what is wheeze? how does it affect breathing?

A

high pitched sound on expiration
- prolonged expiratory phase

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34
Q

what can trigger wheeze?

A
  • Infection (often viral)
  • Cigarette smoke
  • Exercise
  • Dust
  • Pollen
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35
Q

What is Croup? which bit of airway?

A

Viral infection of upper airway => inflam of airway => airway obstruction + breathing difficulty => barking cough + hoarse voice

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36
Q

what will you see on observation of a child with airway obstruction?

A

intercostal recession
subcostal recession
sternal recession
tracheal tug

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37
Q

What does the turbulent airflow in croup cause? sign

A

stridor (inspiratory of expiratory) (harsh sound)
- gets louder as narrowing worsens

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38
Q

why do you need to keep a child with croup calm?

A

if tired (exhausting the kid) => resp failure (so make sure child relaxed)

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39
Q

croup mangement ?

A
  • responded well cos steroids (oral dexamethosome or prednisolone)
  • If severe: nebuliser adrenaline (buys you time while steroids work)
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40
Q

What are the main symtoms of bronchiolitis ?

A
  • sob
  • wheezing
  • wheezy cough
  • runny nose
  • mild temp
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41
Q

in what age group is croup most common in

A

toddlers (6 month - 3 yrs (most common at 1 yr))

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42
Q

in what age group is bronichiolits most common in?

A

1 month - 2 yr

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43
Q

bronchiolitis most common aetiology?

A

viral cause (often resp syncytial virus)

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44
Q

Where in airways is affected in bronchiolitis ? what kind of cough ?

A

infects lower airways => secretions => wet cough

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45
Q

bronchiolitis management ?

A

no specific treatment
- May need to be admitted if hypoxic

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46
Q

generally is viral or bacterial pneumonia worse?

A
  • Viral (self limiting)
  • Bacterial (more unwell, lethargic, temp (>38.5), refuse food)
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47
Q

are signs for subtle or obvious in kids compared to adults with pneumonia

A

kids more subtle clinical signs so CXR

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48
Q

signs of resp distress?

A

tachypnoea
- use of accessory muscles and rescission
- low oxy sats

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49
Q

Difficulty in breathing Hx: what RF are important?

A
  • prematurity
  • Neonatal care required
  • Any cardiac or resp disease
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50
Q

Difficulty in breathing Hx: important things to ask about?

A
  • Cough
  • Feeding
  • Fever
  • Energy levels (drowsy/clingy vs running around)
  • Snuffly nose
  • Activity level
  • Eating and drinking
  • Ability to sleep
  • How ill in past
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51
Q

difficulty in breathing: what do you look for on general examination

A
  • Alertness, interest in surroundings
  • Posture
  • Ability to speak
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52
Q

in what conditions do you get wheezing?

A
  • asthma
  • bronchiolitis
  • viral induced wheeze
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53
Q

In what conditions to you get stridor?

A
  • Croup
  • Foreign body aspiration
  • Anaphylaxis
  • Bacterial trachielitis
  • Epiglotitis
54
Q

in what conditions to you get grunting?

A

sign of significant resp distress (bronchiolitis)

55
Q

Describe the trend of RR and resp distress

A

as resp distress develops => rate goes up to compensate (tachypnoea) => then rate slows

56
Q

what should you also be looking for when calculating RR?

A

work of breathing

57
Q

what 2 things indicate increased respiratory effort?

A
  • recession of the ribs
  • use of accessory muscles
58
Q

what different types of recession (of the ribs) are there?

A
  • Tracheal tug
  • supraclavicular/sternal/intercostal/subcostal recession
59
Q

in which age group is recision of the ribs more likely?

A

younger kids: soft chest wall => pulled in as breath in

60
Q

why types of use of accessory muscles? signs?

A
  • headbobbibg
  • Abdominal breathig
  • nasal flaring (babies)
61
Q

in what condition might you get bronchial breathing?

A

pneumonia

62
Q

how can you quickly know if child has emergency airway problem with choking?

A

if able o talk/cry then unlikely to be emergency airway problem

63
Q

Choking: where is foreign body most often stuck?

A

stuck in oesophagus => encourage to cough

64
Q

Choking: what happens if object stuck in larynx?

A

stuck in larynx => apnoeaic => unconscious or cardiac arrest

65
Q

what would you see if there is inhaled from object in L or R main bronchus on CXR?

A

unilateral hyperinflated lung

66
Q

what is Apnoea? how long?

A

Pause of stopping in breathing (>20 sec)

67
Q

In what conditions might you get apnoea ?

A
  • bronchiolitis
  • whooping cough (pertussis)
  • Sepsis
  • meningitis
    fits
68
Q

what temperature fevers are considered concerning in <3 month old age group and >3 month old age group

A

<3 month: >38 degrees => concerning
>3 month: >39.5 degrees => concerning

69
Q

what are common causes of fever?

A
  • usually infectious cause (most commonly viral and self limiting but some serious bacterial infections)
  • JIA
  • Kawasaki
70
Q

what is the point of the history + examination in a fever presentation?

A
  • Differentiating minor from major infection
  • Source of infection ! think top to toe
71
Q

top to toe: what different infections could there be?

A
  • Meningitis
  • Otitis media
  • Tonsilitis
  • Croup
  • Pneumonia
  • Septic arthritis
  • Osteomyelitis
  • Surgical causes
  • UTI
72
Q

briefly describe sepsis

A

boys response to infection
inflammatory response => increased permeability of blood vessels + poor contraction of heart => loss of circulating fluids => shock and multiple organ failure

73
Q

why does cap refill increased in sepsis?

A

peripheral shutdown (=> increase cap refill) => maintain vital organ perfusion

74
Q

what do you need to ask about a fever Hx?

A
  • The fever itself (temp_
  • Colour: abnormally pale => red flag
  • duration: >5 days is more concerning
  • Eating and drinking
  • Vaccination/immunisation Hx
  • Perinatal Hx: preterm, cerebral palsy
75
Q

how does fever control prevent febrile convulsions?

A

trick question. it doesn’t.
no evidence that tight fever control prevents febrile convulsions.

76
Q

how does fever affect HR? by how much?

A

fever generally increases HR by 10 bpm

77
Q

why is it useful giving an antipyretic (paracetamol/ibuprofen) to child with fever?

A

temp resolving => response to drug (not curing)
- allows you to recheck behaviour and physiology once temp brought down (re check HR + RR)

78
Q

Why don’t rely on BP as a sign of shock?

A

Children have highly effective peripheral shutdown so BP maintained until v sick (decompensated shock)

79
Q

how do you check for cause of fever on examination?

A

top to toe
- check for rash (all over)
- meningitis (bulging fontanel, neck stiffness, photophobia)
- Ottitis media: can often be misleadingly pink due to raised temp
- Chest auscultation
- Abdominal examination
- If nothing found so far: urine sample

80
Q

baby <3 month old with signs of sepsis, what investigation should you consider?

A

consider CXR (babies have very subtle clinical signs for pneumonia)

81
Q

complication of Kawasaki disease?

A

serious heart and CAD complications

82
Q

Describe the symptoms for Kawasaki disease?

A

Fever (usually >39) for at least 5 days + 4/5 of following:
- maculo-papular rash
- conjunctivitis (bilateral, non-purulent)
- mucus membrane changes (strawberry tongue, red lips)
- unilateral cervical lymphadenopathy
- extremity changes: erthyma (palms, soles), swelling of fingers/toes

83
Q

clinical signs of meningococcal septicaemia

A

(signs of circulatory problems)
- bulging fontanel
- Fever
- Rigors
- rash
- Increased RR + HR
- pale or mottled skin
- cold hands and feet
- sleepy/drowsy/difficult to wake
limbs/joints/muscle pain
- confused/delirious
- non blanching purpuric rash

84
Q

what could cause a rash? (6)

A
  • Infection
  • Allergies
  • Reaction to medications
  • Stings and insect bites
  • Chemical irritants
  • Sign of systemic infection
85
Q

usually: what does cough and sore eyes indicate?

A

measles

86
Q

describe a vesticular rash? in what conditions might you see this (3) ?

A

little blisters
- Chicken pox, HSV, shingles

87
Q

Describe petechiae

A

little pink or purple dots <2mm in size

88
Q

describe urticaria? caused by?

A

inflamed looking, itching bumpy rash
- caused by allergy + anaphylaxis

89
Q

child has a rash and a blistered mouth. what condition is this most likely to be and where else would you find blisters?

A

Stevens-Johnson syndrome

causes mouth and other mucus membranes to blister

90
Q

Describe the rash seen in Kawasaki disease

A

non specific but usually macula papular
(widespread erythematous)

91
Q

Describe the rash seen in hence schonlein Purpura and general appearance of the child?

A

immune disease causing bleeding into the skin (similar rash as meningococcal septicaemia but child is generally well

92
Q

Complications of HSP?

A

bleeding also occurs in wall of intestine => abdo pain (+ possible intusscepeption)
- need to diagnose early as can cause kidney disease
- nephrotic syndrome

93
Q

Child has widespread erythema + itching flushing. What is this most likely to be?

A

anaphylaxis - sever allergic reaction

94
Q

describe signs you might find in anaphylaxis A-C?

A

Airway: lip/throat swelling, stridor
Breathing: bronchospasm
Circulation: peripheral vasodilation + hypotension
Diarrhoea

95
Q

What is ITP and what kind of rash does it cause?

A

Idiopathic thrombocytopenia purpura: immune disease affecting platelets (=> clotting disorder)
- causes petechiae in skin (child completely well except rash)

96
Q

ITP diagnosis and management

A

diagnosed with FBC + may need treatment with steroids

97
Q

child presents with petechia or purpura. what do you need to consider ? what test do you need to do

A

Leukaemia
- will appear clinically anaemic
need to do FBC to not miss leukaemia or ITP

98
Q

child presents with a rash mainly affected the legs and buttocks. What is this most likely going to be?

A

HSP

99
Q

child presents with a rash mainly affected face and trunk. what is the most likely going to be?

A

chicken pox

100
Q

causes of non-blanching rash? (3)

A
  • meningococcal septicaemia
  • HSP
  • ITP
101
Q

name some conditions that can cause fits (6)

A
  • Encephalitits
  • Head injury
  • Poisoning
  • Child abuse
  • Febrile convulsions (most common)
  • Breath holding attack
102
Q

Key points to a fits history?

A
  • Any warning signs
  • LOC
  • Appearance during fit
  • Duration
  • Duration of recovery
  • Post even headache
103
Q

Fits history: what to you want to know about the appearance during the fit?

A
  • Eye movements
  • Abnormal movements
  • Colour
  • Tone
  • Incontinence
  • Tongue biting
  • Injuries
104
Q

describe what a Hx would sound like for a non-epileptic event

A

child will describe tunnel vision, sound blurring, incontinence
- swift recovery <1 min

105
Q

Describe when a febrile convulsion occurs and what it looks like

A

tonic clonic following viral infection
- Only lasts a minute and child makes full recovery (but can be a serious infectious cause - pneumonia, meningitis)

106
Q

What might a fit in a baby look like? (3)

A
  • jerking of limbs is less violent + more subtle
  • Stare with eyes upwards
  • Lip smacking
107
Q

Why check blood glucose in a child who had a fit?

A

hypoglycaemia can cause fits in children
- If child unwell preceding fit (+ feeding poorly), type 1 diabetes, congenital metabolic disease + alcohol overdose

108
Q

Why do you have do act quick when a child has been having a seizure for >5 mins

A

status epileptics: if >30 min => brain damage + death

109
Q

generally what 2 ways cause dehydration?

A
  • Lost a lot of fluid
  • Not taking in enough fluid
110
Q

What is the most common cause of dehydration

A

gastroenteritis (rotavirus)

111
Q

What other symptoms are important in a dehydration Hx?

A
  • diccifuly in breathy
  • fever
  • Rash
  • Sore throat
  • Urinary symptoms
112
Q

Dehydrated child with blood in stool. Most likely cause?

A

salmonella/shigella/campylobacter but could be intuessesception

113
Q

what 2 things could jitteriness in babies indicate?

A
  • dehydration
  • hypoglycaemic
114
Q

Signs of dehydration?

A
  • Sunken eyes (ask parent), sunken fontanelle
  • dry mucus membranes (lips, tongue, eyes - sunken + tearless)
  • peripheral temp, mottled kin (due to peripheral vasoconstriction)
  • Skin turgor
  • Capillary refil time
115
Q

in which age group is pyloric stenosis most common?

A

4-6 week age group

116
Q

what causes pyloric stenosis? how does it cause dehydration?

A

muscular swelling at outlet of stomach wchih stops food going into the duodenum => distension => vomiting at end or after feed
forceful projectile vomiting => severe dehydration

117
Q

Explain physiology of hypernatraemic dehydration?

A

babys have immature kidneys => kidney unable to compensate dehydration => imbalance of Na + water => increase blood sodium

118
Q

What should you always consider in a child with moderate-severe dehydration (and increased RR)

A

DKA
(increased RR driven by acidosis)

119
Q

what could the causes of abdominal pain be? (4)

A
  • problem in abdo
  • Infection elsewhere (throat)
  • migraine
  • Stress (school or home)
120
Q

name some abdominal causes of abdominal pain (7)

A
  • Colic
  • Intussusception
  • Meseenteric adenitis
  • Appendicitis
  • Constipation
  • IBD
  • Coeliac disease
121
Q

Name some extra-abdominal causes of abdominal pain (4)

A
  • Migraine
  • DKA
  • Infection elsewhere (pneumonia, UTI)
  • Stress
122
Q

what are the important things you are trying to differentiate in an abdominal pain history? (3)

A
  • Acute vs chronic
  • Medical vs surgical
  • Something serious
123
Q

name some surgical causes of abdominal pain

A
  • Intussusception
  • BO
  • Appendicitis
  • Meckels diverticulum
124
Q

Patient presents with billows vomit, what must you consider

A

bowel obstruction

125
Q

Patient presents with abdominal guarding, fever, increased HR, increased RR. what should you consider? what most commonly causes this?

A

patient is guarding + signs of sepsis
- peritonitis most commonly caused by a perforated appendix

126
Q

Child presents with tonsillitis and sever abdominal pain. what should you consider? explain

A

intussusception (invagination of intestine on itself => BO - life threatening)
- associated with otnsilits + ear infections (make lymph nodes in bowel swell)
(Related to HSP)

127
Q

what is the name of the lymph nodes in bowel

A

Peyers patches

128
Q

what do you have to consider in boys that present with abdominal pain?

A

testicular torsion

129
Q

name some symptoms of cerebral oedema (4)

A
  • Drowsy
  • Out of character
  • Persistent headache
  • Persistent vomiting
130
Q

child present with a head injury. parent says that they vomited. after how many times vomiting should you be concerned? then what would you do?

A

once/twice is quite common
- More => CT scan

131
Q

What questions would you ask for a head injury history?

A
  • Falls Hx: high high, LOC (how long for)
  • behaviour since injury
  • Persistent headache
  • Vomiting since injury
  • Is the Hx consistent (NAI)

3a (43 decks)

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