Paediatrics and Neonatal Flashcards
Manoeuvre if child not protecting their own airway
Jaw thrust
Glucose range in children (normal)
3-5
Foreign Body in Bronchi
CXR findings
Unilateral hyperinflated lung
Kawasaki Disease
- Diagnostic criteria
Fever (>39 for at least 5 days)
4 out of 5 of:
Rash, conjunctivitis, mucous membrane changes, cervical lymphadenopathy, extremity changes
Note: lymphadenopathy may be unilateral
Mucous membrane changes seen in Kawasaki disease (2)
Strawberry tongue
Red fissuring lips
Extremity changes seen in Kawasaki disease (3)
Erythema of palms/soles
Swelling of fingers or toes
Desquamation of fingertips or toes
Adrenaline nebuliser dose used in croup
5ml of 1:1000 adrenaline
Steroid in Croup
Dexamethasone 0.15mg/kg
Steroid in Asthma
Prednisolone 1-2mg/kg (up to 60mg)
RSV Prophylaxis
Palivizumab
Abdominal pain
Preceding viral illness
Normal observations
Mesenteric adenitis
Investigation before starting domperidone
ECG - look for QT prolongation
Symbicort =
Steroid + LABA
Budesonide + Formoterol
Seretide =
Steroid + LABA
Fluticasone + Salmeterol
Rashes in meningococcal sepsis (2)
Non-blanching maculopapular
Blanching erythematous
Vesicles seen in… (3)
Chickenpox
Herpes simplex
Shingles
Petechiae vs purpura
Petechiae <2mm
Purpura >2mm
Erythema multiforme VS Steven Johnson syndrome
EM has NO mucous membrane involvement
Complication of Burns
Toxic Shock Syndrome
Presentation of HSP (3)
Purpuric rash - legs, buttocks
Abdominal pain
Physiologically well
Febrile Convulsions
- Age
- Risk of another convulsion
Usually 1-3 years old
Chance of repeats is ~50%
Differential of vomiting (<6 months) (4)
Posseting
Feeding problems
Pyloric stenosis
GORD
Differential of ‘gastroenteritis’ + abdominal pain (2)
Campylobacter
Surgical cause
Signs of Dehydration in Baby (6)
Sunken eyes Sunken fontanelle Dry mucous membranes Peripheral mottliing Reduced skin turgor Delayed CRT
Hypernatraemic Dehydration
= high [Na+]
- Associated with first few weeks of life where there is difficulty feeding
- Can see high HR and BP, difficult to rouse
- DON’T SEE FONTANELLE CHANGES
Causes of Neonatal Bradycardia (3)
Hypoxia
Congenital Heart Disease
Prematurity
NEC Diagnosis
Clinical Features + Radiological Features
Clinical Features of NEC
Bilious vomiting
Abdominal distension
Blood in stool
Radiological Features of NEC
Dilated bowel loops
Pneumatosis
Hepatobiliary Gas
Management of NEC
Stop feeding and start TPN
Consider antibiotics
May need surgical management
Complication of high bilirubin
Kernicterus
Heel prick test done…
5-9 days of life
Preventing hypoxic brain injury in neonates
Can use cooling measures
Grading Heart Murmurs
1-6
6 is the loudest, above 3 will have a thrill
Erythema toxicum =
Seen post-natally
Entirely normal skin, comes up a few days after birth, completely harmless
Presentation of Scarlet Fever (4)
Sore Throat
Fever
Peri-Oral Pallor
Strawberry Tongue
Cause of Scarlet Fever
Group A Streptococcus
Burn VS Scald
Burn = dry heat Scald = wet heat
Management of Intussusception
Pneumatic reduction under fluoroscopic guidance
Koplik Spots
Seen in measles
= grey blue spots seen in the mouth
Cephalohaematoma VS Caput Succendum
Cephalohaematoma doesn’t cross the sutures
Caput Succendum DOES
Investigating DDH
- Need a hip USS if concerns about Ortolani or Barlow
- Hip USS at 6 weeks if breech delivery or breech after 36 weeks
Pre ductal VS post ductal
Pre ductal = R upper limb
Post ductal = lower limbs
Preductal > Post-Ductal
= differential cyanosis
Aortic arch hypoplasia
Aortic stenosis
Persistent pulmonary hypertension
Signs of Cardiac Failure in Kids (7)
Pallor Cyanosis Tachypnoea Sweating Poor Feeding Increased Work of Breathing Hepatomegaly
Approach to the suspected undescended testicle in the new born
- Check femoral canal to see if there has been maldescension
- Unilateral = reassure should descend without intervention
- Bilateral = senior review and paediatric surgeon referral
Management of hyperbilirubinaemia
Plot on graph to decide whether phototherapy or IV Ig exchange is needed
STOP phototherapy when at least 50mmol/L below the treatment threshold
Mechanism of phototherapy
= transforms bilirubin into water soluble tissues which are more easily eliminated
Respiratory stimulant in neonates
When used
Use caffeine
Helps prevent apnoea and aids extubation
Should be started in <30 weeks or <1501g
Contraindication to use suxamethonium
Duchenne Muscular Dystrophy
Management of meningitis <3 months
Cefotaxime + Amoxicillin (listeria cover)
Tetralogy of Fallot
VSD
Pulmonary Stenosis/Outflow Tract Obstruction
Overriding Aorta
Right Ventricular Hypertrophy
Presentation of RDS (4)
Cyanosis
Nasal Flaring
Increased and shallow breathing
Grunting
Not passed meconium, distended abdomen, bilious vomiting
Meconium ileus
= thickened meconium causes a small bowel obstruction
Occurs secondary to cystic fibrosis
Dose of ceftriaxone
Approx 80mg/kg
How does hypothermia in babies result in hypoxia?
Hypothermia > Hypoglycaemia > Increased o2 demand > Hypoxia
Early onset neonatal sepsis
Group B Streptococcus
Consider E. coli
Late onset neonatal sepsis
Candida
Early VS Late Neonatal Sepsis
Early <72 hours
Late >72 hours
APLS Formula for Estimating Weight
2 x (age +4)
Presentation of Patent Ductus Arteriosus (4)
Continuous machinery like murmur
Left sided thrill
Heaving apex
Widened pulse pressure
Foetal Alcohol Syndrome - Head Size
Microcephaly
Surgical Management of Pyloric Stenosis
Ramstedt Pyloromyotomy
Rash:
Sparing Face =
Starting on Face =
Sparing Face = Scarlet Fever
Starting on Face = Rubella
RDS in Premature
Management
Give surfactant
Deliver via catheter using the ET tube
Investigations for UTI < 3 months
USS at/by 6 weeks after UTI DMSA scan (look at kidneys)
Marker of exocrine pancreas function used in CF
Faecal elastase
Bacteria seen in chest infection in CF (3)
Staph aureus
Haemophilus influenzae
Pseudomonas
Complication of viral gastroenteritis
Transient lactose intolerance
Association of Hirschsprung Disease
Down’s Syndrome
Ix of Choice for C. Aneurysms in Kawasaki’s
ECHO
Paracetamol Dose (Children)
15mg/kg
Eyes and Seizures
Eyes open + no pupil reaction to light
More likely to be a seizure
Choice for terminating seizure (child)
Lorazepam 0.1mg/kg
Startled or injured
Apparent seizure
Consider breath holding attack
Sandiffer Syndrome
= movements appearing like a seizure associated with severe GORD
Resus Fluids in Children
20ml/kg of 0.9% saline over 10 minutes
Maintenance Fluids - Children
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg for next 10kg
All per day
Replacement Fluid - Children
100ml/kg
If appear to be clinically shocked
Development - hand preference
> 12 months
If younger may be a sign of cerebral palsy
Development - hop on one leg
3-4 years
Maternal labetalol can result in…
Neonatal hypoglycaemia
Management of hypoglycaemia in neonate
Factors
Depends on whether symptoms or not
Asymptomatic = nothing
Symptomatic = IV dextrose 10%
Development - pull to stand
9 months
Vomiting since birth
No relation to feeds
Hiatus hernia
Hip XR finding in Perthe’s Disease
Increased femoral head density
Development - suck reflex
Usually 33-34 weeks gestation
Infection of Chicken Pox > Necrotising Fasciitis
Group A Strep
Management of Scarlet Fever
Penicillin V
Can go back to education 24 hours after starting ABx
Management of Kawasaki’s Disease
Aspirin
Single dose of IV immunoglobulin
Decision about management of PDA
Factor
Depends on whether it is in isolation or occurs with another defect
Isolation = give indomethacin to close
Another defect = prostaglandin to keep it open until surgery can be done
Maintenance Fluids in Children
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg for every kg afterwards
Common association with measles
Otitis Media
Age of birth risk for neonatal hypoglycaemia
< 37 weeks
Sequelae of Roseola Infantum
- Cause
- High fever
- Maculopapular rash
- Febrile convulsions, diarrhoea and cough
Cause = human herpes virus 6
Pulse sites to check infant BLS
Brachial
Femoral
Investigation of suspected intusseption
Abdominal USS
Transposition of Arteries
How is it compatible with life?
It isn’t, there must be an associated defect which allows for mixing of blood
e.g. PDA = continuous machine like murmur
What is imprinting?
Example?
= inherit the faulty gene from one parent and the other gene is ‘silenced’ even if it is normal
e.g. Prader Willi
Management of Neonatal Hypoglycaemia
Defined as <2.6
Asymptomatic = normal feeding, monitor BMs
Symptomatic or very low <1 = need IV infusion of 10% dextrose
What type of vaccine is the rotavirus vaccine?
Oral live attenuated
Bilirubin in biliary atresia
See a conjugated hyperbilirubinaemia
Presentation of hypothyroidism in children (2)
Small stature
Lethargy
Heart disease seen in congenital rubella
Patent PDA
Croup + Well + Stridor
Need admission - stridor indicates admission
Asthma in child not controlled by leukotriene + SABA + ICS - next step?
Stop leukotriene
Add in LABA
