paeds Flashcards
why is grunting a sound made during severe resp distress?
caused by exhaling with the glottis partially closed to increase positive end expiratory pressure -trying to keep airways open n
what is an important complication to screen for in kawasaki disease and how do you screen for it?
coronary artery aneurysms
echocardiagram
what is the classic scarlet fever rash?
‘sandpaper’ rash
why does down’s syndrome cause sleep apnoea and snoring?
low muscle tone in upper airways and large tongue /adenoids
increased risk of obesity -another predisposing factor to snoring
what are the causes of snoring in children?
obesity
nasal problems (polyps, deviated septum, hypertrophic nasal turbinates)
recurrent tonsilitis
down’s syndrome
hypothyroidism
what is the first sign of puberty in males and females?
males -testicular growth at around 12 years of age
females -breast development at around 11.5 years of age
what rate should chest compressions be done for all children?
100-120bpm
how do you measure temperature in different ages of children?
<4 weeks old: electronic thermometer in axilla
4 weeks or older: use electronic/chemical dot thermometer in axilla or infra-red tympanic.
what is the temperature level that’s a red flag in different ages of babies?
if under 3 months: >38
if 3-6 months: >39
hypothermia in <1m old-sepsis red flag
what drug is usually given if encephalitis is suspected in a febrile child
acyclovir
what are the key non-infective differentials for children who have fevers for more than 5 days?
kawasaki disease
still’s disease (systemic JIA)
rheumatic fever
leukaemia
what sort of vaccine is the polio one?
inactivated
what are some important vaccines that are live vaccines?
MMR
BCG
oral polio (not used in this country anymore because we have it in the 6in1 but used in developing countries)
typhoid
yellow fever
what are the 2 peaks for T1DM presentation in children?
4-6yo and 10-14yo
how long does insulin stay in the body?
half life 6 min, cleared from circulation completely in 10-15min.
what are the key newborn screenings?
NIPE, 6 week examination, new born hearing screening, neonatal heel pick blood spot
what is in the heel prick test?
sickle cell, CF, congenital hypothyroidism, 6 inherited metabolic diseases (PKU, MCADD, MSUD, IVA, GA1, HCU)
what is the management of binge eating disorder in children?
1st line =guided self help programmes
2nd line (unacceptable or ineffective after 4 weeks)-group CBT-ED
3rd line =individual CBT-ED
when do you consider inotropes in management of paeds sepsis and which ones could be given peripherally?
if normal physiological parameters are’nt restored after >or equal to 40ml/kg of fluids
adrenaline or dopamine, peripheral IV or IO
what is the treatment of SUFE?
INTERNAL fixation
what is thelarche?
also known as breast budding
is the onset of secondary breast development.
what is the most common cause of stridor in children and how does it present?
laryngomalacia
usually presents with stridor in first 4 weeks of age
what is the most common causative organism in the UK of early onset neonatal sepsis?
group B strep
what is the actual thing they’re testing for in the heel prick test for CF and what’s the next step?
immunoreactive trypsingogen (IRT) -raised is positive. if raised they get a sweat test.
when can you give adrenaline in a neonatal resus situation?
if bradycardic <60bpm
why is aspirin contraindicated in kids <16 (unless specific circumstances)?
risk of reyes syndrome -disease of liver and brain. MOA unknown but something to do with mitochondria getting damaged. causes repeated vomiting, seizures, lethargy, tachypnoea.
what age is adenovirus most common in?
1-4
what is the classic presentation of adenovirus?
classic triad -URTI, conjunctivitis, GI symptoms (diarrhoea/change in bowel habit)
how long does adenovirus usually take to resolve itself?
7-21 days
what are the clinical features of mumps?
fever, malaise, muscular pain, parotitis
what can parotitis present as?
‘ear pain’, ‘pain on eating’ ‘sore throat’
what are the complications of mumps?
swollen testicles
viral meningitis
encephalitis
what is the transmission route for mumps?
respiratory
how do you diagnose HHV1 or 2?
PCR test of lesion, CSF, or blood
what antivirals can you use for HHV1/2?
acyclovir, valacyclovir
what is dress syndrome?
delayed hypersensitivity reaction to a drug causing fever, rash, lymphadenopathy, haematological abnormalities and organ involvement. can be caused by a lot of drugs.
how does carbamazepine work and what are its notable side effects?
inhibits sodium channels
agranulocytosis (low WCC)
aplastic anaemia (bone marrow not making enough blood cells)
induces p450-many drug interactions
what are the notable side effects of phenytoin?
folate and vit D deficiency
who can pure tone audiometry be used on?
people over 3yo.
which test is 1stline for vesicoureteric reflux?
MCUG (micturating cysturethrogam)
what is a DMSA scan?
nuclear medicine scan of kidneys -to detect renal morphology structure and function
where are inhaled foreign bodies most likely to be found?
right main bronchus
which sort of CP can kernicturus lead to?
dyskinetic CP -bilirubin loves to lurk in basal ganglia appaz
what’s the difference in presentation of post strep glomerulonephritis and IgA nephropathy?
post strep -7-14 days after strep infection
IgA nephropathy -1-3 days post URTI
what do you need to make sure you do with a child post head injury?
don’t leave them alone in 1st 24 hours
what makes up the apgar scoring and what is its significance?
a-appearance
p-pulse
g-grimace (‘reflex irritability’)
a-activity (muscle tone)
r-respiration (breathing rate and effort)
needs to be performed on every live newborn at 1 and 5 minutes of life.
7-10=reassuring
4-6=moderately abnormal
0-3=low
what is the management of neonatal hypoglcyaemia?
symptomatic -glucose 10% IV infusion and retest BM in 15 minutes. if delay in IV access consider buccal glucose gel or IM glucagon (but still do the IV)
asx -increase breast feeding frequency, can supplement with formula/buccal glucose gel. check BMs in 1h to ensure response.
if ineffective: same infusion
what can you do to try and prevent neonatal hypoglycaemia once baby is born?
feeding early and regularly, keeping baby warm
what is the initial and definitive managements of hirschpring’s?
initial-rectal washouts/bowel irrigation
definitive -surgery
what is the management of mild depression in children?
watchful waiting for 2 weeks then review
if nothing changes psych therapies for 2-3 months
if no response refer to cahms
what is the treatment of moderate or severe depression in children?
immediate cahms review
aged 12-18: 3 months of individual CBT, consider fluoxetine alongside or 2nd line
what are the normal and abnormal heart rates at birth?
> 100 =satisfactory
60-100 =intermediate, possible hypoxia
<60 =critical, hypoxia likely
what syndrome is linked to angelman?
prader willi -from mum
what is the management of constipation in kids?
macrogol (movicol) -1st line
stool softener eg lactulose, docusate -can add
stimulant 2nd line -senna, bisacodyl, dulcolax
what is the most common cause of painless massive GI bleeding requiring transfusion in children between ages 1 and 2?
meckel’s diverticulum
when is soiling considered patholigical?
4 years old
what is in the heelprick test?
sickle cell
CF
congenital hypothyroidism
metabolic diseases
when is the newborn hearing test done and what is it?
screening -everyone should get it
age 4-5 weeks ideally, can be done up to 3 months
otoacoustic emission test
what is the treatment for whooping cough?
if 21 days or less since onset -azithro/clarithro
if >21 days: advice and supportive
what is infantile colic?
common and benign set of sx -excessive crying, pulling up legs, worse at night usually and usually <3m
what is the murmur caused by ASD?
ESM loudest in pulm area and fixed splitting of S2
because L->R shunt increases loading time of RV and more blood going through pulm valve
in tet of fallot what determines clinical severity?
degree of pulmonary stenosis (RV outflow obstruction)
what is the classic presentation of patellar tendonitis?
chronic knee pain -worse after movement, tender below patella o/e
what is the diagnostic investigation for reflux nephropathy?
MCUG (micturating cystography)
which sex is perthe’s more common in?
boys-5x more common
