Paeds Flashcards
1
Q
newborn Mx immediately after birth
A
skin to skin contact clamp umbilical cord dry baby keep baby warm - hat & blankets vit K (babies are born with deficiency vit K - IM vit K in thigh) label baby weigh baby
2
Q
newborn Mx - out of the delivery room
A
newborn examination within 24hrs
blood spot test
hearing test
3
Q
newborn resusitation (rapid action needed for a baby who doesn’t breathe within 30 seconds of birth or who exibits slow gasping. Bradycardia also indicates hypoxia. What is the Mx
A
warm, vigorous drying
(babies under 28wks placed in a plastic bag and go under heat lamp)
APGAR score
if gasping / unable to breathe consider aspiration using suction catheter
can also give inflation breaths - give O2 with bag-valve mask
still no responce - chest compressions, consider intubation & IV drugs
4
Q
If baby near or at term and has prolonged hypoxia therefore at v high risk hypoxic ischaemic encephalopathy (HIE) what is Mx
A
theapeutic hypothermia
5
Q
salmon patch - aka nevus simplex - very common what is Mx
A
usually fades by age 2
6
Q
haemangionmas - blood vessels that form a raised red lump on the skin - usually shrink by age 7 but when is Tx indicated
A
if they affect vision, breathing or feeding
7
Q
mouding = change of head shape during delivery - what is Mx
A
its common & resolves in a couple of days
8
Q
heart mumurs are very common in babies & most relate to transition from foetal to neonatal circulatory pattern - what is Mx
A
disappear after first few days
9
Q
Mx neonatal jaundice
A
phototherapy
exchange transfusion - excahnge of babies blood with donated blood / plasma in order to decrease circulating levels of bilirubin
10
Q
mongolian blue spot (blue / grey lesions in the sacral area) Mx
A
do not require Mx
11
Q
cafe au lait spots Mx
A
are themselves benign but may indicate neurofibromatosis type 1,
12
Q
neonatal milia (tiny white bumps) Mx
A
clear by themselves & no Tx is needed - parental reassurance
13
Q
erythema toxium (small erythematous papules & vesicles) - can appear & disappear quite rapidly - Mx?
A
reassurance
14
Q
capillary haemangiomas (raised red lump on the skin, get bigger up to 1 year in age and then shink & diappear by age 7) - require Tx if affecting vision, breathing or feeding - what is Tx
A
steroid injection
15
Q
port wine stain - type of birth mark that grows as child grows & therefore stays into adulthood (sometimes associated with genetic diseases) what can improve lesions?
A
laser therapy
16
Q
caphalohaematoma (subperiosteal haemorhages - does not cross the midline). Mx
A
most resolve spontaneously
(but do monitor for signs of jaundice & anaemia)
CT FU a few months later
17
Q
haemolytic disease (maternal IgG antibodies cross the palcenta & reacts with foetal blood & antigens e.g ABO incompatibility + rhesus incompatibility) - Mx
A
antiD at 28 wks - prevention
if it does occur - wash out maternal antibodies by series exchange transfusion
aggressive phototherapy
intravenous immunoglobulin
18
Q
initial Mx of premature bith happens antentally - what can be given
A
steroids
mag sulphate
19
Q
prematurity - respiratory Mx e.g RDS, surfacatnt lung disease, bronchopulmonary dysplasia
A
exogenous surfactant intubation & mechanical ventilation high flow O2 intubators caffine administartion for apnoeas
20
Q
prematuraity - cardiovasuclar Mx e.g hypotension, perfusion abnormalities, patent ductus arteriosus
A
inotrope infusion (e.g adrenaline, noradrenaline, dopamine) fluid Mx
21
Q
prematurity neurological Mx - intraventricular haemorrhages, seizures, developmental delay
A
survelliance with CrUSS
regular head circumferance measurements
antiepileptic drugs e.g phenobarbital, phenytoin
neurodevelopmental FU
22
Q
prematurity GI Mx - e.g immature gut causing feed intolerance, necroising enterocolitis
A
TPN
ABx therapy
surgical r/v if necrotoising enterocolitis suspected
23
Q
prematurity - renal Mx e.g immature renal funstion
A
fluid management
electrolyte supplements
catheristaion if needed
24
Q
prematurity - metabolic Mx e.g jaundice, hyper/hypoglycaemia
A
phototherapy exchange transfusion, insulin transfusion
25
prematurity complictions - sepsis Mx
septic screen
| IV ABx
26
prematurity - skin & thermoregulation Mx - immature skin barrier leading to infection, water loss & decreased thermoregulation
incubator use
| aseptic tecnique
27
prematurity - eyes Mx e.g retinopathy of prematurity
avoid XS oxygen exposure
| optahlmology input & laser therapy if needed
28
RDS (antenatally steroids are given) postnatal Mx?
surfactant replacement therapy
| assisted ventilation - mechanical ventilation, CPAP, supplementary O2
29
talipes (club foot) Mx - postural talipes
physio
30
talipes (club foot) Mx - structural talipes - talipes equinovarus
orthopaedic referral for splitage or surgery
31
talipes (club foot) - strucutral talipes - talpies calcaneovalgus Mx
usually self corrects
32
bacterial meningitis Mx
```
IM benzypenicillin in GP
under 3 months - cefotaxime + amocillin IV
over 3 months - ceftriaxone IV
steroids - dexa - to avoid hearing loss
notifiable disease
```
33
viral meningitis Mx
usually milder than bacterial
| aciclovir can be used
34
septicameia Mx
A to E
BUFALO (IV or IO ABx)
children are patricularly prone to hypoglycaemia when unwell therefore can give bolus dextrose)
35
chicken pox (VZV) Mx
supportive & avoid pregnant women until crusted over
aciclovir - immunocompromised pt, adults & adolescents over 14yrs presenting with 24hrs serious infection
36
viral conjunctivities Mx
usually self limiting
37
bacterial meningitis Mx
chloramephenicol
38
food allergy Mx
exclude the allergen form the diet
eduaction on allergica attcak - epipen
antihistamines
for mild reactions
39
infectious mononucelosis Mx
usually slef limiting
but can cuase fatigue for several months
no contact sport for 8wks - risk spenic rupture
limit spread by not kissing / using utensils
40
kawaksaki disease Mx
IV immunoglobulins
| high dose aspirin
41
reyes syndrome - progressive encephalopathy - aitiology not fully understood but known assoication aspirin. what is Mx
supportive
42
measles Mx
paracetamol / ibuprofen to relieve fever, aches & pains
drink water
stay off school for at least 4 days
43
periorbital cellulitis Mx
admission
| oral co-amoxiclav
44
prophylaxis Tx baby HIV is mums viral load is less than 50 copies per ml
zidovudine for 4 wks
45
high risk babies mums viral laod is more than 50 copies per ml
zidovudine
lamivudine and
nevirapine for 4 wks
46
rubella - mild diseaes in childhood. Typically occurs in winter & spring Mx
supportive
47
rubella antentally less than 12 wks Mx
high liklihood defects - reasonable to consider TOP
48
rubella infection Mx 12-20wks antenatally
12-20 wks - TOP or suvelliance of pregancy by USS to identify features of congentital rubella syndrome
49
rubella infection Mx more than 20 wks antenatally
no action requires
50
acute asthma Mx
1st line - oxygen
salbuatmol nebs
ipratropium bromide (can be added to neb)
stetoids (3 days) oral pred
2nd line - IV salbutamol, mag sulphate
51
chronic Mx asthma (stepwise approach adding more in if not well controlled)
short acting beta agonist - salbutamol
ICS - e.g beclomathasone
LABA - salmetrol
then can add LRTA - montelukast
52
epglottitus Mx (life threatening infection caused by haempophilus influenzae - swelling of eppiglotis)
if suspect epiglottitus don't examine throat
anaethetic
blood cultures
& IV ceftriaxone
53
tonisllitus - meets the centor criteria
benzlypenicillin then swtch to oral penicillin V when can swallow
paracet / ibuprofen for pain relief
tonsillectomy if meet criteria for recurrent tonisllitus
54
quincy (collection of pus in peritonsillar space) Mx
incision & drainage
55
croup Mx - admission depenedent on how severe. If severe group what is Mx
single dose oral dex
| might need nebulised adrenaline
56
bronchioloitis - most cases can be managed at home with supportive measures e.g fluids, nutrition, temp control. Hospital admission if severe / underlying condition e.g CF. Mx?
oxygen
fluids
consider CPAP if reduced oral intake
airway suctioning if secretions
57
pneumonia Mx
amoxicillin
(can add erythromycin if atypical)
oxygen
58
CF Mx is by an MDT approach - airway clearance & sx mx
physiotherapy
mucolytics
uf chest infection - ABx, and prophylactic ABX needed in infants up to 3 yrs
regualr azithromycin to reduce exacerbations & improve lung function
59
CF Mx is by an MDT approach - nourishment & excercise
creon when eating meals
vit d & e supplements as these are fat soluble vitamins
build up milkshakes as children with CF have poor wt gain
60
Mx of acute inhaled foreign body
encourage to cough
back blows / chest thrusts
beguin CPR
61
Mx inhaled foreign body with late presentation - wheeze, stridor, infection
CXR
| laryngoscopy / bronchoscopy for confirmation & retrieval
62
acute otitis media Mx - usually resolves itself & supportive Mx. However if child has discahrge or systemicall unwell or bilateral OM then the Mx
amoxicillin 5 days
63
TB Tx
rifampicin
isoniazid
ethambutol
pyrazinamide
64
whooping cough Mx - usually supportive Mx but may require admission to hospital for what Mx
fluids etc
| ABx do not alter the clinical course of disease but can reduce period of infectivity therefore clarithromycin given
65
iron deficiency anaemia Mx
dietary advice & supplemetal oral iron (e.g iron salts)
66
management sickle cell anaemia (general)
avoid dehydration & other triggers
vaccines up to date (suseptible to infection)
ABx prophylaxis - e.g penicllin
blood transfusions - severe anaemia
hydroxycarbamide (if recurrent hospital admissions for painful vaso-occulsive crises)
67
management acute sickle cell crisis
oral or IV analgesia
good hydration
warmth
O2
68
thalassemia Tx
regualar blood transfusions & SC deferoxamine
69
haemophilia Tx
infusions of affected factor - 7 or 8
TXA
desmospressin to stimulate the relesase of vWF
70
HSP Mx
supportive
(seroids used to Tx severe GI pain / renal involvement)
monitor BP & urine dipstick
71
leukameia Mx - immediate Mx
hyperhydration (to prevent viscosity)
steroids immediately
definitive Tx - MDT & primarily Tx with chemo
72
lymphoma immediate Mx
high dose steroids
if SVCO - stenting to keep veins patent
if tumour lysis syndrome - hyperhydration & allopuroinol can also be used
definitive - chemotherapy & possibly radiotherapy
73
1st line brain tumours kids
surgery
| also chemo / radio can be considered
74
neuroblastoma Mx
surgery with chemo / radio if metastatic - unfortunately most children over 1 year present with advance disease and therefore have poor prognosis
75
wilms tumour Mx
initial chemo and then delayed nephrotomy
76
tetraology of fallot Mx
CXR - boot shaped heart
ECG - right ventricular hypertrophy
echo- right to left shunt
surical repair
77
atrial spetal defect - Mx - referral to paediatric cardiologist
if ASD is small & asymptomatic - watch & wait - can resolve spontaneously
surgery - transvenous catheter
anticoagulants - aspirin, warfarin, NOACs - reduce risk of clots & stroke in adults
78
patent ductus arteriosus Mx
indomethacin or ibuprofen - inhibits prostaglandin synthesis & therefore closes the connection
79
coarctation of aorta
prostaglandin E used to keep ductus arteriosus open whilst waiting for surgery
surgery then to correct coarctation & ligate ductus arteriosus
80
transposition of great vessels Mx
maintainence ductus arteriousus with prostaglandins
| surgicxal correction = definitive Tx
81
constipation & soiling - step 1 dietary Mx
high fibre foods
| stool softners - fruit, veg, water/juice
82
constipation & soiling step 2 Mx - disimpaction
laxatives
| manual excavation under GA - required in extreme cases usually children other problems e.g learning difficulties
83
prevention soiling / constipation kids
encourage daily bowel movement
esablish a good toilet routine
diet & excercise
84
gastroenerteristis Mx
main concern gastroeneteritis = dehydration
if admitted - isolate the pt
IV fluids
ABx not generally recommended / required
85
reflux in newborns
reassurance - ususally improves with age
| if breastfed with frequent regurg causing marked distress - use gaviscon after feeds
86
vomiting - pyloric stenosis Mx
correct any fluid disturbance
| definitive Tx = pyloromyotomy
87
whooping cough - highly infectious disease caused by bacterium bordetella pertussis - Mx if acutely unwell, breathing difficulties, feding difficulties, significant complications e.g penumonia (mostly supportive Mx is enough for wooping cough)
swab
clarithromycin if under 1 month
azithromycin or clarithromycin for over 1 month
88
cows milk protein allergy Mx
avoid cow milk
| in infants that are formula fed need hypoallergenic formula
89
abdo pain - appendicitis - Mx
admission
IV ABx
surgery - in some cases but not all - contact surgery team
surgical removal appendix - laproscopy gold standard
90
coeliac disease Mx
lifelong gluten free diet
| might need supplements e.g iron
91
intususeption Mx
A to E & monitor for signs bowel perforamtion
enemas
contrast, water & air pumped into colon to reduce the intususcpetion
if bowel becomes gangrenous / performated - surgical resection required
92
mesenteric adenitis = inflammation mesenteric lymph nodes.
rule out appendicitis
| reassurance - give analegia if needed
93
inguinal hernia Mx
most can be sucessful reduced by 'taxis' = gentle compression in the line of inguinal canal
surgery then planned for sutible time when any odema settled
if reduction is impossible - emergency surgery
surgery = ligation & division processus vaginalis
94
testicular tortion Mx - 6 hr window before becomes iscahemic becomes irreversible
strong analgesia & nil by mouth
surgery - fix testicles in place : orchiplexy
possible orchiectomy if necrotic testicle
95
undescended testis (crytochidism) Mx
watch & wait in newborns (if not descened by 6 months refer to paediatric urologist)
surgical correction of undescended testis between 6months - 1 year
96
biliary atresia (section of bile duct is narrowed or absent) - Mx
surgery
97
hirschsprungs disease (congenital condition where nerve calls of mesenteric plexus absent in distal bowel + rectum). Hirsprungs associated enterocloitis (inflammation + obstruction intestine occuring in 20% neonates with hirsprungs) Mx
life threatening due to risk toxic megacolon & bowel perforation
urgent ABx
fluid resus
decompression obstructed bowel
rectal biopsy to demonstrate hirschsprungs diagnosis
definitive Mx - surgical removal aganglionic section of bowel
98
failure to thrive Mx
MDT inpit - regular r/v to monitor wt gain
CAMHS if ?neglect
urinalysis to exclude UTI
bloods - metabolic condition, elminate infection
coeliac screen
sweat test if ?CF
USS if ?pyloric stenosis
99
DKA Mx
admission
fluids0.9% NaCl with 20mmol K in 500ml bag
insulin IV - delyaed after beguinning IV fluid therapy - this has been shown to reduce chance of cerebral oedema
100
chronic MX DM kids
```
eduaction pathophysiology
injection of insulin - tecnique and sites (lipodystrophy)
finger pick testing
diet
encourage to excercise
adjust insulin during illness
recognise hypoglycaemia
diabetes UK
```
101
hypogkycaemia Mx
early stage - lucozade / sugary drink
if child uncooperative - oral glucose gels
late stage - glucagon IM followed by biscuit / sandwhich
102
obesity Mx
siet, excercise, behavioural therapy
orlistat
103
hypothyroidism Mx
levothyroxine
104
PKU Mx
diet low in phenylalanine and high in tyrosine
105
febrile fit Mx (Mx usually involves explanation of relatively beign nature of febrile convulsions & if occurs at home put child into recovery position). what happens if seizure more than 5 mins
call ambulance
| lorazepam IV or biccal midazolam
106
head injury Mx when would you do a head CT
```
post traumatic seizure (but no epilepsy Hx)
lowered GCS
sign of basal skull fract
neurological deficit
non-accidental injury
LOC lasting mire than 5 mins
amnesia lasting more than 5 mins
drowsiness
3+ episodes of vomiting
dangerous mechanism of injury
```
107
Mx epilepsy (following EEG) - focal seizures
carbamezepine or lamotrigine
108
Mx epilepsy - general tonic clonic
sodium valproate
| lamotrigene if child bearing age
109
Mx absence seizures
sodium val
110
Mx myoclonic seizures
sodium val
111
Mx tonic or atonic seizures
sodium val
112
infantile spasms Mx
steroid or vigabatrin
113
lifetsyle Mx for epilieptic patients
```
fit free for 12 months before can drive again
warfain is CI with antiepileptics
folic acids in preg
take contracepetion
risk of osteoporosis with antiepileptics
```
114
what diet can be considered for children with epilepsy
ketogenic diet
115
breath holding attack Mx
exclude other pathology - exclude neurological definict
eduaction & reassurance
also breath holding attacks have been linked to iron def anaemia
116
acute Mx during a seizure
```
A to E
100% O2 via non-rebreathe mask
IV acess for bloods
check blood sugar
Iv lirazepam
anaethetic help
```
117
hydrocephalus Mx - 1st line in acute setting
external ventricular drain
118
long term Mx of hydrocepahlus
ventricular shunt system
119
migraine Mx
```
avoid known triggers
medication overuse headache
simple analgesia - paracetamol, ibuprofen (don't give aspirin - risk of reyes syndrome)
nasal triptin
antiemetic e.g prochlorperazine
```
120
1st line prevention migraines in children
propanolol
| pizotifen
121
plagiocephaly (flattening of one side of babies head) - Mx
reassurance - majority of cases head returns to normal as child grows
poistion on round side of head
supervised tunny lying time
122
craniosynotosis (premature fusion of skull bones) Mx
mild cases - monitored & FU
| severe cases - surgery & surgical reconstruction skull
123
Tics Mx
education - emphasize that anxiety, stress, tiredness & stimulants can worsen tics
reassurance
if significant impact on life - CAMS referral - might have Sx suggestive of OCD / ASD / ADHD
treat secondary causes
if Tx requires; habit reversal training / CBT / rispiridone / haloperidol
124
enuresis & wetting Mx
lifestyle changes - reduced fluid intake in evenings & lifting is avoided as it trains the child to void whilst half asleep
positive reinforcement e.g star charts
treat underlying cause e.g UTI / DM / constipation
safeguarding if needed
125
interventions for enuresis / wetting usually recommended after age 7
enuresis alarms
desmopressin
oxybutanin
126
UTI Mx - all children under 3 months with a fever should start what?
immediate IV ABx - ceftriaxone
| and full septic screen
127
for lower UTI in kids Mx
trimethoprim
or
nitrofurantoin
128
for pyleonephritis in kids Mx
cefalexin
or
amoxicillin
129
nephrotic syndrome (triad of proteinuria/oedema/hypoalbuminaemia). Mx =
almost always due to minimal change disease - Mx =
prednisolone]law salt diet & fluid restriction
furosemide to treat odema (not usually recmmoneded)
daily weights - avoid intravascular volumne depletion & secondary AKI
prophylactic ABx - increased risk infection due to immunoglobulins loss in urine
130
haematuria Mx
treat cause e.g UTI, glomerulonephritis, HSP
renal stone - USS
look out for red flags - abnormal renal function / proteinuria / fluid overload e.g odema, ascites, elevated JVP / HTN / frant haematuria
131
haemolytic uraemic syndrome Mx (triad of AKI, microangiopathic haemolytic anaemia, thrombocytopenia)
Medical emergency - self limiting & needs supportive Mx - fluids, blood transfusions, antihypertensives, dialysis
ACEi are good to give too
132
eczema Mx
avoid extremes in temp / humidity / irritating clothes (wool)
nails short
avoid soaps / detergent
emollients - after washing & in direction of hair growth
corticosteroids - mild to potent (hydrocoristone / bentrovate / derovate = v potent)
itchiness - antihistamines
secondary bacterial infections - flucloxacillin
133
impetigo Mx - general advice
avoid touching
| off school for at least 48 hrs
134
impetigo Mx - non-bullous
localised & non systemic = hydrogen peroxide cream
widespread & non systemic = topical Abx (fusidic acid) or oral ABx (flucloxacillin)
135
impetigo Mx - bullous impetigo or systemically unwell
oral fkucloxicillin
136
nappy rash Mx
```
highly absorbant nappies
gentle products for cleaning the nappy area
ensure nappy area is dry
maximise time not wearing a nappy
barrier protection for the skin
if inflammed - topical hydrocortisone
```
137
thrush - candida in the nappy area
barrier protection
| clotrimazole cream
138
stevens-johnstons syndrome (disproportionate immune responce that causes epidermal necrosis) Mx
```
hospital admission
fluids
stop the causative drug agent
dressing analgesia
opthalomolgy
(systemic ABx if signs infection)
cleanse wounds with chorhexidine solution & greasy emollient
```
139
erythema nodosum (can be caused by infections / IBD/ sarcoidosis) Mx
investigate for underlying condition
rest & analegsia
most spontaneously resolve within 8 wks
140
scabies Mx - remember to check finger webs & track marks.
permethrin cream all over body
| treat everyone else in the house too
141
septic arthritis mx
```
admission
aspirate
start empirical ABx - flucloxacillin IV
analgesics
orthopaedic input
```
142
reactive arthritis Mx
exclude septic arthritis (aspiration & culture)
splint joint
NSAIDs and/ or steroids
usually resolves within 6 months
143
developmental dysplasia of the hip Mx
pavlik harness
| after 6 months - surgery
144
irritable hip (transient synovitis) Mx
vital signs & rule out septic arthritis
| self limiting - needs rest and simple analgesia
145
juvenile idiopathic arthritis Mx
initiate paediatric rheumatology referral
symptom control - nsaids, splinting
inducing remission - steroids / physio
maintainence - methotrexate / sulfasazine / influximab
146
perthe's disease - idiopathic avascular necrosis to femoral head - Mx
keep femoral head in acetabulum - cast , braces
147
slipped femoral epiphysis (when the head of the femur is displaced cuases femoral head to move posterioinferiorly) Mx
surgical - internal fixation
148
malnutrition Mx
nutritional support
| be careful of refeeding sybdrome - give pabrinex to prevent this & phosphate
149
osetomalacia Mx
supplementary vit D - colecalciferol
150
rickets Mx
vit D & calcium supplementation
151
cerebral palsy Mx - MDT
physio - strengthen muscles
occupational therapy - manage everyday activities
speech & language therapy - help with speech & swallowing
dieticians
orthopaedic surgeons - relsease contractures
muscle relaxants e.g baclofen for muscle spacitity
XS drooling - glycopyrronium bromide
152
Downs syndrome Mx - MDT
cardiology (ASD, VSD, patent ductus arteriosus)
physiotherapy
dietician
ENT (recurrent OM) & deafness
opthalmology (myopia, cataracts, squint)
speech & langauge (learning difficulty)
leukaemia more common children with downs
dementia more common in adults with downs
153
autism Mx
```
behavioural Mx - visual timetables, preparation & explanation for changes in routine
educational measures
CAMHS
speech and language
social workers
```
154
squint (misalignment of visual axis due either to imbalance in extraocular muscles or paralysis extraocular msucles) Mx
opthalmology - eye patch, atropine drops, corrective glasses, surgery
155
deafness Mx - MDT
```
speech and language therapy
education psychology
ENT specialist
hearing aids
sign language
```
156
temper tantrum
```
avoid triggers - hunger / tiredness
distraction
stay calm
reward good behaviour
use time out
```
157
anxiety disorders
```
understanding
guided imagery
mindfulness
avoid alcholol / caffine / drugs
rescue brething
excercise
CBT
SSRIs e.g sertraline
```
158
ADHD Mx
parents - eduacation & training
| drug therapy - last resort & over age 5 - 1st line = methypenidate
159
delibberate self harm Mx
urgent psychiatric assess
CAMHS input
CBT
