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4th Year - Management > Paediatrics - Management > Flashcards

Paediatrics - Management Flashcards

1
Q

Neonatal Jaundice - Examinations

A

Press skin to blanch
Yellowing of sclera
Yellowing of skin (cranio-caudal)

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2
Q

Neonatal Jaundice - Investigations

A 
Split bilirubin (conjugated vs unconjugated) 
Plot on chart
Direct Coombes test (agglutination of RBC)
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3
Q

Neonatal Jaundice - Treatment

A

Plot bilirubin chart on graph

  • Phototherapy
  • Exchange transfusion
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4
Q

Neonatal Jaundice - Complications

A

Kernicticus

  • Unconjugated bilirubin crosses blood brain barrier
  • Causes sensorineural deafness, seizures, coma, opisthotonus (arched back), poor feeding.
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5
Q

Immunisations - At Birth

A
  • BCG for TB if high risk population (live)

- Hep B if mother is +ve

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6
Q

Immunisations - 2 months

A
  • Rotavirus
  • PCV
  • Men B
  • 5 in 1 (diptheria, tetanus, pertussis, polio, HIb)
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7
Q

Immunisations - 3 months

A
  • Rotavirus

- 5 in 1

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8
Q

Immunisations - 4 months

A
  • Men B
  • PCV
  • 5 in 1
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9
Q

Immunisations - 12 months

A
  • Hib
  • Men C
  • Men B
  • PCV
  • MMR
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10
Q

Immunisations - 3y 4m

A
  • DTaP/IPV (4 in 1)

- MMR

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11
Q

Immunisations - 2-7 years

A
  • Influenza
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12
Q

Immunisations - 12 years (girls)

A
  • HPV
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13
Q

Immunisations - 12-17 years

A
  • Td (Diptheria and tetanus)

- IPV

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14
Q

Meningitis - Signs

A
  • Brudinski’s sign - flexion of neck laid down causes flexion of hips
  • Kernig’s sign - back pain on extension of the knee
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15
Q

Meningitis - Bloods

A
  • FBC (high WCC)
  • CRP
  • U&Es
  • Glucose
  • Clotting
  • Blood cultures
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16
Q

Meningitis - LP results

A 
Bacterial (BNBN)
- high neutrophils, low glucose, turbid
Viral 
- high lymphoctes, clear, normal protein
TB
- lymphocytes, very high protein, low glucose
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17
Q

Meningitis - Causes

A

Neonate

  • Group B Strep,
  • listeria monocytogenes
  • E coli

1 month - 6 years

  • Nesseria meningitidis
  • Strep pneumoniae
  • H. influenza

> 4 years

  • Nessieria meningitidis
  • Strep Pnuemoniae
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18
Q

Meningitis - Antibiotics (for bacterial)

Prophylaxis for household contacts

A

ABCDE Approach

<3 months
- Cefotaxime + amoxicillin

> 3 months
- Ceftriaxone

  • Rifampicin for household contacts
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19
Q

Meningitis - Complications

A
  • Hearing loss
  • Local vasculitis
  • Local infarction -> seizures -> epilepsy
  • Hydrocephalus
  • Cerebral abscess
  • Subdural effusion
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20
Q

Purpura - Description

A

Purple discolouration of the skin <1cm

Indicative of vasculitis and bleeding under the skin

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21
Q

Purpura - Causes and Presentation

A

Meningococcal septicaemia
- Systemically unwell child

Henoch-Schonlein Purpura

  • Abdo pain, swelling in legs and ankles
  • Well child
  • Haematuria: do a urine dip

Immune thrombocytopenia (ITP)

  • 1-3 weeks post viral infection, self resolving
  • FBC - platelets <20 is concerning
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22
Q

Septicaemia - Examination

A
  • High Temp
  • High RR, High HR
  • Low BP, late sign
  • Purpuric Rash
  • Evidence of end organ damage
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23
Q

Septicaemia - Management

A

ABCDE Approach

- Stabilise and transfer to PICU

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24
Q

Iron Deficiency Anaemia - Hb

A
  • Neonate <14
  • 1-12 months <10
  • 1-13 years <11

May only be symptomatic at 6-7

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25
Q

Iron Deficiency Anaemia - Investigations

A
  • FBC (low Hb, low MCV)
  • Blood film (microcytic, hypochromic)
  • Low ferritin (poor iron stores)
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26
Q

Iron Deficiency Anaemia - Management

A
  • Dietary advice (red meat, leafy green vegetables)
  • Syntron supplementation until Hb is normal, then for another 3 months to replenish stores
  • Failure to respond - consider non dietary cause

Blood transfusions not necessary for diet related

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27
Q

Innocent Murmur - Characteristics (7 s’)

A
  • Systolic
  • Soft (<3)
  • Sounds normal (HS 1+2)
  • Symptom-less
  • Special tests normal
  • Standing/sitting
  • Still (does not radiate)
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28
Q

Asthma - Examination

A
  • May be NAD
  • Harrison sulci (depression at diaphragm)
  • Hyperinflated, barrel chest
  • Wheeze/prolonged expiration
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29
Q

Asthma - Investigations

A

PEFR diary

Most likely diagnosis
- Begin treatment and monitor response
Intermediate likelihood
- Spirometry to assess for obstructive pattern

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30
Q

Asthma - Management

A

Step 1
- SABA

Step 2
- SABA and ICS (100-200mg bd)

Step 3

  • Add LABA (salmetarol)
  • If no effect, stop LABA, try LTRA, increase ICS to 400mg

Step 4
- ICS to 800mg

Step 5
- Oral steroid (Prednisolone)

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31
Q

Asthma - Review

A
  • Inhaler technique
  • Symptom control
  • School attendance
  • Mood
  • Triggers (smoking, pets, cold, exercise)
  • Growth
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32
Q

Bronchiolitis - Examination

A
  • Bilateral wheeze
  • Fine crackles
  • Over expansion of chest
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33
Q

Bronchiolitis - Imaging

A

CXR

  • Hyperinflation
  • Patch collapse/consolidation
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34
Q

Bronchiolitis - Mild disease

A
  • No resp distress
  • Feeding >50%
  • No risk factors

Send home WITH SAFETY NETTING

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35
Q

Bronchiolitis - Management

A

Admit if feeding <50%

Supportive therapy

  • O2 to aim for sats >92%
  • IV Fluids
  • NGT feeding if required
  • Assisted ventilation

May be discharged when successful trial without O2 for 12 hours

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36
Q

Mild Croup - Symptoms

A
  • Occasional cough
  • No resp distress
  • Sats >94%
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37
Q

Mild Croup - Management

A

Reassure parents

Discharge with safety netting (stridor)

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38
Q

Moderate Croup - Symptoms

A
  • Barking cough
  • Intermittent stridor
  • Mild resp distress
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39
Q

Moderate Croup - Management

A

Oral steroids
- Dexamethasone/prednisolone

Nebulised steroids
- Budesonide

Low threshold for admitting <12 months due to risk or airway narrowing

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40
Q

Severe Croup - Symptoms

A
  • Severe resp. distress
  • Fatigue
  • Altered mental state
  • Cyanosis
  • Sats <92%
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41
Q

Severe Croup - Management

A

ABCDE Approach

  • O2 therapy
  • Oral steroids
  • Nebulised adrenaline
  • CALL ANAESTHETIST
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42
Q

Epiglottitis - Examination

A

DO NOT EXAMINE THROAT

  • Drooling, excessive saliva
  • high RR, HR,
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43
Q

Epiglottitis - Management

A

CONTACT ANAESTHETIST

  • Intubation
  • Steroids
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44
Q

Epiglottits - Antibiotics + Prophylaxis

A

Ceftrioxone for 7 days

Rifampicin for household contacts

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45
Q

Pneumonia - Causes

A 
Newborn
- Group B strep
Infants
- RSV, strep pneumoniae
School age
- Strep pneumoniae, mycoplasma, chlamydia

CONSIDER TB

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46
Q

Pneumonia - Severe, needs admitting (IV abx)

A 
- Resp distress : increased RR, grunting, nasal flaring, 
   accessory muscle use
- O2 sats <93%
- Cyanosis around mouth
- Reduced oral intake
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47
Q

Pneumonia - Mild, treat at home (oral abx)

A
  • No resp distress
  • 02 Sats >93%
  • PU and taking fluids
  • Unilateral local chest signs
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48
Q

Pneumonia - Antibiotics

A

<5 years
- Amoxicillin for strep pneumoniae

> 5 years
- Erythromycin for mycoplasma

If severe/staph aureus

  • Co-amoxiclav
  • Cefotaxime
  • Ceftriaxone
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49
Q

Tonsillitis - Criteria

A

Centor criteria (likelihood of strep A infection)

  • Absence of cough
  • history of fever
  • White exudate
  • Cervical lymphadenopathy
  • Under 15 years
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50
Q

Tonsillitis - Management

A 
0-1 = no abx
2-3 = throat swab then abx 
4-5 = abx and rapid swab

Give penecillin/erythromycin for 10 days
NO AMOXICILLIN

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51
Q

Tonsillitis - Tonsillectomy indications

A
  • Recurrent
  • Quinsy (peri-tonsillar abcess)
  • Obstructive sleep apnoea
52
Q

Acute Otitis Media - Management

A

Most resolve spontaneously

- Co-amoxiclav/Amox if systemically unwell

53
Q

Glue Ear - Management

A
  • Self resolving

- Grommets if conductive hearing loss

54
Q

Wheeze - Viral induced (+RF)

A
  • <5 years
  • Episodic
  • Absence of atopy

RF - prematurity and maternal smoking

55
Q

Wheeze - Recurrent

A
  • > 5 years

- IgE: dust, pollens, pets

56
Q

Cystic Fibrosis - Examination

A
  • Hyperinflation of chest
  • Crepitations
  • Expiratory wheeze
  • Clubbing
  • Low growth and weight
57
Q

Cystic Fibrosis - Investigations

A
  • Guthrie test (Day 5-8)
  • Sweat test (diagnostic) - Cl >60
  • Genetic CFTR mutation
  • CXR: hyperinflation, bronchiectasis
  • Spirometry = obstructive
58
Q

Cystic Fibrosis - Respiratory Management

A
  • Physiotherapy BD to clear secretions
  • Abx prophylaxis with penicillin
  • Anti puedemonas nebulisers
  • Bronchodilators
  • Mucolytics (saline neb)
59
Q

Cystic Fibrosis - Nutritional Management

A
  • Creon to replace pancreatic enzymes
  • kCal 150% intake
  • ADEK vitamin supplements
60
Q

Constipation - Red Flags

A

No meconium in first 48 hours, increased abdo distention - Hirschprung’s

Reduced growth - hypothyroid, coeliac disease

Sacral dimple - Spina biffida

Bruising - sexual abuse

Fissures - Chron’s

61
Q

Constipation - Behavioral Management

A
  • Increase oral intake (10 cups of water a day)
  • Increase fibre in diet (fresh fruit and veg)
  • Regular toilet time after meals
  • Reassure parents
62
Q

Constipation - Medication

A 
Disimpaction
- Movicol up to 4 sachets daily for 2 weeks 
If not working
- Senna
Then consider
- Enema or manual evacuation (referral)

Maintenance 3 months (Movicol OD)

63
Q

Gastroenteritis - Causes

A

Viral - faeco-oral

  • Rotavirus (winter)
  • Adenovirus, norovirus)

Bacterial - blood in stools

  • Campylobactor
  • Shigella, salmonella, e-coli
64
Q

Gastroenteritis - Investigations

A
  • Weight (to record level of dehydration)
  • Fluid status (urine output, BP, HR)

If severe:

  • U&Es
  • Capillary blood gas (Metabolic acidosis - H+ loss from vomiting, bicarb loss from diarrhoea)
65
Q

Gastroenteritis - Management

A

0-5% dehydration - Encourage oral fluids

5-10% - ORS, 50ml/kg over 4 hours

10% - shock

66
Q

Calculate fluid deficit

A

dehydration (%) x weight x 10

  • Give in addition to maintainance fluids
67
Q

Management of shock

A
  • 20ml/kg fluid bolus (0.9% saline)
  • 10ml/kg in DKA/trauma
  • Replace deficit + give maintenance
68
Q

Maintenance fluids

A

0.45 % saline and 5% dextrose

100ml for first 10kg
50ml for 2nd 10 kg
20 for subsequent kg

69
Q

Clinical Shock

A
  • High HR, Low BP,
  • Sunken eyes
  • Dry mucous membranes
70
Q

GORD - Feeding Management

A

Bottle feeding

  • Do not overfeed ( <200ml/kg/day
  • Nurse at 30 degrees

General
- Do not lie on back straight away (1 hour)

71
Q

GORD - Medication

A
  • Thickening feeds (bottle or paste for breast)
  • Gaviscon
  • PPI/domperidone (rare)
72
Q

Vomiting - Classification

A

Non-forceful

  • Possetting, small amounts with air
  • Regurgitation, larger more frequent losses

Forceful
- Vomiting, ejection of contents

73
Q

Vomiting - Red Flags

A

Bilious - obstruction

Projectile, first weeks of life - pyloric stenosis

Blood in stool - intususseption

Bulging fontanelle/seizures - raised ICP

74
Q

Vomiting - Management

A

Oral/IV Fluids

  • Capillary blood gas to assess if metabolic acidosis
  • Electrolyte replacement

Medications

  • Anti-emetic e.g. cyclazine
  • 5HT3 antagonists - ondansetron
75
Q

Diabetes - Investigations

A

Diagnostic

  • BM >11
  • Fasting BM >7.0

Urine

  • Glucose +++
  • Ketones +++
76
Q

Diabetes - Hypo

A
  • Sugary drink then complex carb, recheck BM in 15 mins

- IM Glucagon 0.5-1mg or 5mg/kg glucose IV

77
Q

Diabetes - DKA

A

ABCDE approach

  • Fluid resus (10ml/kg)
  • Fixed rate insulin (continue long acting)
78
Q

Diabetes - Education

A
  • Insulin management
  • Benefits of good control
  • Support with school
  • Hypo/hyper management
  • Sick day rules
79
Q

Diabetes - Insulin regimes

A

Twice daily

  • Long acting and short acting mix
  • Before breakfast and dinner

Basal bolus (most physiological)

  • Long acting at night
  • Short acting before each meal (carb counting)

Infusion Pump

  • Continuous basal rate with bolus dosing
  • Based on continuous BM monitoring
80
Q

Failure to Thrive - Classification

A
  • Fall of more than 2 centiles in weight

- On or below second centile

81
Q

FtT - Cause

A

G - Genetically determined (metabolic)
I - Inadequate intake ( unskilled feeding, too little breastmilk)
V - Vomiting - GORD
F - Failure to utilise: infection, hypothyroid, Heartfailure, renal failure
E - Emotional deprivation - neglect, domestic violence
D - Digestion problems - coeliac, cystic fibrosis

82
Q

FtT - Investigations

A
  • Accurate growth measurements
  • Check breastfeeding technique
  • Sweat test, stool test, urine dip
  • FBC, U&Es, glucose, LFTs,
83
Q

FtT - Management

A

Treat underlying pathology

Increase feeds if due to poor intake
Involve dietician

84
Q

Febrile fits - Simple

A
  • 6 months to 6 years
  • Single seizure
  • <15 minutes
  • No neuro defecit before or after
  • Fever not due to CNS infection
85
Q

Febrile Fits - Complex

A
  • > 15 minutes duration
  • focal seizure
  • Multiple seizures in same fever
  • status epilepticus
86
Q

Febrile Fits - Advice to parents

A
  • 1/3 risk of recurrence
  • Manage fever, increase oral intake
  • No increased risk of epilepsy with one convulsion
87
Q

Management of fitting child

A 
- Keep safe (not fall off, not near sharps, nothing in 
   mouth)
- Time fit 
- Recovery position
- >5 minutes call ambulance
88
Q

Status Epilepticus - Management

A

ABCDE

  • Buccal lorazepam/rectal diazepam
  • IV lorazapam/diazepam
  • IV phenytoin
  • Call anaesthetist
89
Q

Eneuresis - Classification

A

Primary
- Dry periods (if any) less than 6 months

Secondary

  • Wetting after period of dryness >6 months
  • Pathological cause
90
Q

Eneuresis - Investigations

A

Urine dip
- DM: Glucose
- UTI - nitrites
Psychological screening

91
Q

Eneuresis - Initial Management

A

Behavioural

  • Increase fluid intake in the day to increase bladder capacity
  • Voiding before bed
  • No fizzy drinks
  • Reassurance re condition (very common)
92
Q

Eneuresis - Further Management

A
  1. Star chat
    - Behaviours such as voiding before bed
  2. Eneuresis alarm
    - Over 7 years
  3. Desmopressin
    - Reduce urine production, for special occasions e.g. holiday, sleepovers
93
Q

UTI - Investigations

A

Urine dip

- Nitrites/WCCs

94
Q

Eczema - Examination

A

Infants
- Behind ears, scalp and cheeks

Children
- Skin Flexures

95
Q

Eczema - Management

A

Emollients

  • Use as much as possible
  • Consistent application

Sterioids

  • Hydrocortisone
  • sparing use: 1 fingertip to 1 palm size

Prevent scratching

  • antihistamines
  • mittens at night
96
Q

Septic A - Examinations

A
  • Hot and swollen joint
  • fever and systemic illness
  • Pain on active and passive movement
97
Q

Septic A - Investigations

A

Bloods

  • FBC
  • CRP
  • Culture if systemically unwell

Joint X-ray
- widening of joint space

Joint aspiration

  • Purulent fluid
  • Infection confirmed
98
Q

Septic A - Management

A
  • Contact orthopaedics
  • Surgical joint wash our
  • High dose IV flucoxacillin
99
Q

Septic A - Follow Up

A
  • 3 weeks oral Abx
  • 2 year follow up with orthopaedics
  • risk of cartilage and growth plate damage
100
Q

Cerebral Palsy - Infantile Presentation

A
  • Poor sucking
  • Hypotonia
  • Persistent Primitive reflexes
  • Delayed development
101
Q

Cerebral Palsy - Child Presentation

A
  • Spasticity (contracted muscles)
  • Ataxia (reduced co-ordination)
  • Dyskinesia (involuntary movements)
102
Q

Cerebral Palsy - Investigations

A

Rule out related conditions

  • Epilepsy
  • Learning Disability
  • Vision/hearing defects
103
Q

Cerebral Palsy - Management

A
  • Physio and Speech Therapy
  • Botox injections
  • Adductor release surgery
  • OT: wheelchairs, walking aids
104
Q

Down’s Syndrome - Features

A
  • Brachycephaly (flat occiput)
  • Epicanthal folds
  • Almond shaped eyes
  • Tongue Protrusion
  • Short Fingers
  • Single palmar crease
  • Sandal gap
105
Q

Down’s Syndrome - Medical Problems

A

Spectrum!

  • Learning difficulty
  • AVSD heart defect
  • Duodenal atresia
  • Early alzheimer’s
106
Q

Down’s Syndrome - Investigations

A
  • Developmental assessment (only social normal)
  • ECHO
  • Hearing test
  • TFTs (hypothyroid)
107
Q

Down’s Syndrome - Management

A
  • Special education assessment
  • Genetic counselling and support

Monitoring

  • risk of otitis media
  • hypothyroid
  • leukaemia
  • respiratory infections
108
Q

Squint - Classification

A

Paralytic
- Squint varies with direction of eyes

Non-paralytic

  • squint constant
  • may be manifest (always), or latent (when tired)
109
Q

Squint - Examination

A

Corneal Reflection

  • Shine light in eyes, ask for straight gaze
  • Symmetrical reflection if no squint

Cover Test

  • Cover good eye
  • Watch which way squint flicks when covered
110
Q

Squint - Types of non-paralytic

A

Convergent
- To midline

Divergent

  • Outwards
  • Pathological
111
Q

Squint - Management (3 O’s)

A

Refer to ophthalmology

Optical
- refractive error corrections with glasses

Orthoptic
- patching of good eye to increase use of squint eye

Operation
- rectus muscle realignment

112
Q

Squint - Complications

A

Untreated

  • suppressed vision in affected eye to prevent diplopia
  • cortical blindness
113
Q

Behaviour - ABC

A

A - What happened before/trigger

B - What is the behaviour?

C - Consequences of behaviour?

114
Q

Colic - Advice

A
  • Feeding position
  • Winding
  • Carry rather than lay down flat
  • Keep breast feeding
  • Limit mum’s cows milk consumption
  • Resolves by 3 months
115
Q

Sleeping - Advice

A
  • Clear bed time routine

Controlled crying
- Leave for 5 minutes, then 10 etc

  • Firm and consistent approach
116
Q

Tantrums - Advice

A
  • Avoid situation (not overtired/ hungry)
  • Ignore
  • Firm and consistent approach
  • Time out (1 min/year of age)
117
Q

Aggressive Behaviour - Advice

A
  • Reassure is common
  • Time outs
  • Star charts for good behaviour
  • If persistent, refer
118
Q

Star Charts

A
  • Must concern behaviour that can be controlled
  • Won for good behaviour
  • Give straight away
  • Cannot be lost for bad behaviour
  • Decide value of stars beforehand
  • Child can decorate chart
119
Q

UTI - Urine Dip Results

A

Leukocytes +ve, Nitrites +ve = UTI
Leukocytes -ve, Nitrites +ve = Abx, urine culture
Leukocytes +ve, Nitrites -ve =Abx if clinical UTI
Leukocytes -ve, Nitrites -ve = Unlikely

120
Q

UTI - < 6M, typical

A

Renal USS 6 weeks after

121
Q

UTI - Abx

A

ORAL - trimethoprim, co-amoxiclav
IV - Cefuroxime, gentamicin

<3 months

  • Admit
  • IV abx (local guidelines)

> 3 months (upper)

  • Oral abx 7-10 days
  • IV abx 2-4 days

> 3 months (lower)
- Oral abx 3 days

122
Q

Septic Screen

A

LP

Blood cultures

Urine dip/culture

CXR only if resp symptoms

123
Q

UTI <6 M, atypical or recurrent

A

USS KUB 6 weeks after

DMSA/MCUG

124
Q

UTI 6M-3Y Typical

A

No imaging

125
Q

UTI - 6M-3Y atypical/recurrent

A

USs KUB

DMSA

4th Year - Management (11 decks)

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