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ICM - OBS > PAEDs > Flashcards

PAEDs Flashcards

1
Q

What is an absolute indication for a CT head in a child

A

GCS <14 on initial assessment

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2
Q

Which blood test has different normal values in children compared with adults

A

Hb

WBC

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3
Q

Which test is included on the neonatal

blood spot test?

A
  1. Cystic Fibrosis
    - immunoreactive trysinogen
  2. Sickle Cell Disease
    - HPLC (high-powered Liquid Chromotography)
    Congenital
  3. Hypothyroidism
  4. 6 types of Inherited Metabolic Disorders:
    - Galctosemia
    - Maple Syrup Disease (MSUD)
    - medium chan acyl-coenzyme A dehydrogenase defienceicy (MCADD)
    - Phyenylketonuria (PKU)
    - Homocystinuria (HSU)
    - Glutaric Acidaemia Type 1 (GA1)
    - Isovaleric Acidaemia (VA)
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4
Q

What blood test values stay the same in paeds + adults?

A

INR
CRP
D-Dimer

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5
Q

Why is ALP raised in children?

A

ALP raised due to bone metabolism from growth and bone marrow maturing

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6
Q

Indications for capillary blood gas

A
  1. Arterial blood gas analysis is indicated but arterial access is not available.
  2. Noninvasive monitor readings are abnormal: transcutaneous values, end-tidal CO2, pulse oximetry.
  3. Assessment of initiation, administration, or change in therapeutic modalities (ie, mechanical ventilation) is indicated.
  4. Monitoring the severity and progression of a documented disease process is desirable
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7
Q

Indication of urine collection

A
  1. UTI

2. Or any other conditions that can be picked up in the urine.

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8
Q

Indication for heel prick

A
  1. Most routine blood tests requiring less than 1ml of blood
  2. Metabolic and genetic screening tests
  3. Blood glucose and Lactate analysis
  4. Blood gases
  5. Newborn Blood spot screening
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9
Q

Ix for septic child

A
  1. blood gas for glucose and lactate
  2. blood culture
  3. FBC ( WCC)
  4. C-reactive protein
  5. urea and electrolytes
  6. creatinine
  7. clotting screen
  8. Procalcitonin ( raised in bacterial sepsis)
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10
Q

Indication for LP in child

A

if aged < 2month or <3 months AND ‘appear unwell’ OR WBC <5 / >15

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11
Q

Classic signs of meningitis in children

A
  1. Neck stiffness
  2. Bulging Fontanelle
  3. High-Pitched cry/ Irritable
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12
Q

If you suspect meningitis in a child, what Ix must you do?

A

LP

CT head if:
GCS <10
focal neuro
fluctuating consciousness

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13
Q

DDx for acute limp < 3y/o

A
  1. Fracture/ soft tissue injury

2. Developmental dysplasia of hip - where ball and socket of hip fail to develop normally

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14
Q

DDx for acute limp 3-10 y/o

A
  1. Transient synovitis - self limiting inflammatory hip disorder (diagnosis of exclusion - afebrile & common inboys, less likely under 3yrs)
  2. Fracture/ soft tissue injury
  3. Legg - Calve- Perthes disease - idiopathic avascular necrosis of developing femoral head (common in boys vs girls)
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15
Q

DDx for acute limp 10-19 y/o

A
  1. Fractue/ soft tissue
  2. SCFE - slipped upper femoral epiphysis - displacement of proximal femoral epiphysis from metaphysis - more common in boys
  3. Legg - Calve- Perthes disease
  4. Osgood schlatter disease - damage to patella ligament (anterior) by overuse injury - self limiting
  5. Chondromalacia patellae - anterior knee pain walking up or down stairs
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16
Q

DDx for acute limp in all ages

A
  1. Septic arthritis - infection of synovium + joint space -> joint destruction, loss of function and sepsis. Present w/ refusal to weight bear and fever. Blood cultures.
  2. Osteomyelitis - bone infection and lead to destruction
  3. Both may mimic transient synovitis (rare in <3yrs olds)
  4. Malignancy
  5. Metabolic disease - eg rickets (low vit D)
  6. Juvenile idiopathic arthritis - inflammatory joint disease in children
17
Q

Ix for bronchiolitis

A
  1. 02 sats measurement <92%

2. No investigations required for bronchiolitis- usually a clinical diagnosis.

18
Q

Ix for febrile seizures

A
  1. Clinical diagnosis- seziure with fever
  2. LP- to test for meningitis to consider.
  3. Blood culture, viral studies
  4. EEG
  5. Serum sodium low–> seizures
  6. Glucose, iron studies and FBC
19
Q

CT head within 1 hour indications in children:

A
  1. Clinical suspicion of NAI
  2. Post-traumatic seizure (no PMHx epilepsy)
  3. GCS <14 on initial assessment
    - -> if <1 year, GCS <15
  4. GCS <15 2hrs after injury
  5. Suspected open or depressed skull fracture or tense fontanelle
  6. Signs of base of skull fracture
  7. Focal neurological deficit
  8. Aged <1 - bruise, swelling or laceration >5 cm on the head
20
Q

CT head indications after observing for 4 hours

A
  1. Witnessed LOC >5 mins
  2. Amnesia (antegrade or retrograde) >5 mins
  3. Abnormal drowsiness
  4. ≥3 Discrete episodes of vomiting
  5. Dangerous mechanism of injury

if only 1 of the above:
OBSERVE 4 Hrs

Then CT Head if:
GCS <15
Vomiting
Drowsiness

ICM - OBS (18 decks)

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