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MRCEM INTERMEDIATE > Paediatrics & Neonatology > Flashcards

Paediatrics & Neonatology Flashcards

1
Q

Maintenance fluid calculator for children

A

Routine maintenance fluids for children are calculated by weight using the Holliday-Segar formula:

100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg

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2
Q

Initial fluid bolus in shock for children

A

10ml/kg

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3
Q

If child required a bolus for shock, how much fluid should be added to maintenance to rehydrate?

A

Add 100ml/kg

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4
Q

If child did not require a bolus for shock, how much fluid should be added to maintenance to rehydrate?

A

Add 50ml/kg

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5
Q

When is jaundice physiological in neonates ?

A

Usually appears at day 2, peaks 3-5, gone by 10 days

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6
Q

Neonatal sepsis abx choice

A

Ben Pen and Gent

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7
Q

Continuous murmur in a neonate most likely?

A

Machinery murmur -> PDA

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8
Q

Most common cause of early onset neonatal sepsis =

A

Group B strep

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9
Q

Kocher criteria for osteomyeletis in children

A

non-weight-bearing status, fever>38.5°C, white blood cell>12 K, and erythrocyte sedimentation rate>40 mm/h

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10
Q

How to diagnose SUFD on XR

A

Klein’s line, if it doesn’t transcect the femoral epiphysis it is a positive Trethowan’s sign

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11
Q

School exclusion advice for whooping cough

A

Can return 48hrs after abx started or 21 days if not treated

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12
Q

Treatment for whooping cough

A

Clarithromycin

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13
Q

Treating cerebral oedema in a child with DKA

A

Mannitol or hypertonic saine

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14
Q

NLS, CRP ratio

A

3:1

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15
Q

Pre ductal SpO2 accepted

2 mins
5mins
10 mins

A

65%
85%
90%

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16
Q

5th disease is dangerous to who?

A

Pregnant women - causes marrow problems in the fetus
Sick cell

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17
Q

What to do in children with a fever of 38 or higher (unexplained)

A

Urine dipstick

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18
Q

Fever in

1 month old

1-3 month old + unwell

A

Treat with IV Abx

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19
Q

Treatment for Kawasaki

A

HIGH dose aspirin
and IgG

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20
Q

BRUE low risk

A

Age > 60 days
Born >32 wks gestation post conceptual age > 45 days

No CPR
< 1 min
1st event

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21
Q

Calculation for fluid to replace % dehydration

A

10 x weight x %

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22
Q

Most common cause for early onset neonatal sepsis

A

Group B strep

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23
Q

Cyanotic CHDs

A

Tetraology of fallot
Transposition of GA
Tricuspid atresia
Total anomalous pulmonary vascular return
Truncus arteriosus

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24
Q

When to admit a neonate with Jaundice

A

< 24hr hours old
or < 35 weeks gestation

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25
Q

Most concerning complication of neonatal jaundice

A

Kernicterus (encephalopathy)

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26
Q

Shock strength for children

A

4J/Kg

27
Q

After rescue breaths in NLS, at what HR do we then commence CPR

A

<60 BPM

28
Q

Upper limit of RR for children of certain ages

6-12 month
>12 months

A

50 breaths/min

40

29
Q

Upper limit of HR for children of certain ages

< 12 months
12-24 months
2-5 yrs

A

160

150

140

30
Q

Temp of concern in:

3-6 months

< 3months

A

39

38

31
Q

How to monitor temp in a child < 4 weeks old

A

Temp probe in the axilla

32
Q

Dose of Ben Pen in the community for meningitis (suspected)

<1 yr

1-9 yrs

10+ yrs

A

300

600

1.2g

32
Q

Burns (>10%) in children calculation

A

% X KG X 3 (over 24hrs)

33
Q

Shock in SVT in children

A

DC synchronous shock at 1-2 J/kg.

34
Q

Westle croup score

A
35
Q

DKA in children, over what time frame should deficit be corrected?

A

48hrs

36
Q

Calculating fluid requirement in DKA in a child

A

When calculating the fluid requirement for children and young people with DKA, assume a 5% fluid deficit in mild-to-moderate DKA (indicated by a blood pH of 7.1 or above), or a 10% fluid deficit in severe DKA (indicated by a blood pH below 7.1).

The total replacement fluid to be given over 48 hours is calculated as follows:

Hourly rate = (deficit/48 hours) + maintenance per hour

37
Q

Treatment for cerebral oedema following DKA tx in children

A

If cerebral oedema occurs, treat with hypertonic (3%) saline 3 ml/kg or a mannitol infusion (250-500 mg/kg over 20 min).

38
Q

Causes of pneumonia in

Term / near term infants

Low birth weight infants

A

Group B haemolytic Streptococcus

E.coli

39
Q

APGAR scoring for

Appearance (skin colour)

0
1
2

A

Blue or pale all over

Blue at extremities (acrocyanosis)

No cyanosis Body and extremities pink

40
Q

APGAR scoring for

Pulse

0
1
2

A

Absent
<100
>100

41
Q

APGAR scoring for

Grimace

0
1
2

A

No response to stimulation

Grimace on suction or aggressive stimulation

Cry on stimulation

42
Q

APGAR scoring for

Activity

0
1
2

A

None

Some limb flexion

Flexed arms and legs that resist extension

43
Q

APGAR scoring for

Respiratory effort

0
1
2

A

None

Weak, irregular, gasping

Strong cry

44
Q

4 categories of neonatal jaundice

A

Haemolytic unconjugated hyperbilirubinaemia

Non-haemolytic unconjugated hyperbilirubinaemia

Hepatic conjugated hyperbilirubinaemia

Post-hepatic conjugated hyperbilirubinaemia

45
Q

Which type of neonatal jaundice is always pathological?

A

Conjugated

46
Q

Haemolytic unconjugated hyperbilirubinaemia is split into 2 categories

A

Intrinsic

Extrinsic

47
Q

Haemolytic unconjugated hyperbilirubinaemia

Intrinsic causes of haemolysis

A

Hereditary spherocytosis
G6PD deficiency
Sickle-cell disease
Pyruvate kinase deficiency

48
Q

Haemolytic unconjugated hyperbilirubinaemia

Extrinsic causes of haemolysis:

A

Haemolytic disease of the newborn
Rhesus disease

49
Q

Non-haemolytic unconjugated hyperbilirubinaemia causes

A

Breastmilk jaundice
Cephalhaematoma
Polycythemia
Infection (particularly urinary tract infections)
Gilbert syndrome

50
Q

Hepatic conjugated hyperbilirubinaemia causes

A

Hepatitis A and B
TORCH infections
Galactosaemia
Alpha 1-antitrypsin deficiency
Drugs

51
Q

Post-hepatic conjugated hyperbilirubinaemia causes

A

Biliary atresia
Bile duct obstruction
Choledochal cysts

52
Q

Tetralogy of fallot is associated with which congenital syndromes (4)

A

DiGeorge syndrome (22q11 microdeletion syndrome)
Trisomy 21
Foetal alcohol syndrome
Maternal phenylketonuria

53
Q

Pyloric stenosis blood gas

A

hypochloraemic metabolic alkalosis

54
Q

When should an APGAR assessment be done after birth?

A

1 & 5 mins

55
Q

Dose of prednisolone in children with asthma exacerbation

Age 2-5

Age 5+

If already on a maintenance dose of pred

A

Use a dose of 20 mg prednisolone for children aged 2–5 years and a dose of 30–40 mg for children >5 years.

Those already receiving maintenance steroid tablets should receive 2 mg/kg prednisolone up to a maximum dose of 60 mg.

56
Q

When is magnseium added to salbutamol nebs in the management of paediatric asthma?

A

Consider adding 150 mg magnesium sulphate to each nebulised salbutamol and ipratropium in the first hour in children with a short duration of acute severe asthma symptoms presenting with an oxygen saturation less than 92%.

57
Q

Defining tachypnoea in different age groups

0-5 months

6-12 months

12 months +

A

RR >60 breaths/minute, age 0-5 months;
RR >50 breaths/minute, age 6-12 months;
RR >40 breaths/minute, age older than 12 months

58
Q

Severe asthma attacks in children characterised by?

Age 2-5

5+

A

RR >40, HR >140

RR >30, HR > 125

59
Q

SpO2 indicating life threatening asthma in children?

A

<92%

59
Q

Dosing of benzos in status epilepticus (paediatrics)

Lorazepam IV / IO

Buccal midazolam

Rectal diazepam

A

Lorazepam 0.1 mg/kg

Buccal midazolam 0.5 mg/kg

or rectal diazepam 0.5 mg/kg

60
Q

Step 3 in paediatric SE (after 2nd benzo)

A

IV levetiracetam, 40mg/kg (max 3g) over 5 mins

61
Q

Paediatric epilepsy

If seizures continue despite loading with levetiracetam then termination with induction of anaesthesia and intubation is expected. However, if the advanced airway team is not yet prepared and the ABCDE assessment is stable, then:

A

If not already on phenytoin, then a phenytoin infusion should be set up (20 mg/kg IV infusion over 20 minutes)

If already taking phenytoin, then phenobarbitone can be used in its place (20 mg/kg IV infusion over 20 minutes)

62
Q

Anatomical land mark of needle thoracocentesis for
tension pneumothorax in children?

A

2nd IC space, mid clavicular line

MRCEM INTERMEDIATE (18 decks)

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