Paeds Flashcards
Causes of meningitis in neonates
Group B strep, E.coli and listeria monocytogenes
Causes of meningitis in 1 month-6 years
N. meningitidis, strep.pneumonia and Hib
Causes of meningitis > 6 years
N. meningitidis and strep. pneumoniae
History for meningitis
Fever, headache, photophobia, lethargy, vomiting, poor feeding, irritability, hypotonia, loss of consciousness/ drowsy and seizure
May be non-specific in young
Examination findings for meningitis
Fever, neck stiffness, purpuric rash, bulging fontanelle, opisthotonus, brudzinski and kernig signs, papilloedema, focal neurological signs, signs of shock
What is brudzinski sign
flexion of the neck when the child is supine causes flexion of the knees and hips
What is kernig’s sign
When the child is lying supine, and hips and knees are flexed there is back pain when the knee is extended
Investigations for meningitis
bloods, blood culture, throat swab, urine and stool culture, rapid antigen test for microorganisms, viral PCR, lumbar puncture, consider MRI/CT
When is lumbar puncture contraindicated
cardiorespiratory instability
focal neurological signs
signs of raised ICP (papilloedema)
coagulopathy
thrombocytopenia
local infection
LP findings for bacterial meningitis
Turbid appearance
raised polymorphs
raised protein
low glucose
LP findings for viral meningitis
Clear appearance
raised lymphocytes
normal/ raised protein
normal/ low glucose
LP findings for TB meningitis
turbid/clear
raised lymphocytes
very raised protein
very low glucose
Treatment of bacterial meningitis
IV ceftriaxone
supportive care
consider dexamethasone
prophylaxis of meningitis
rifampicin or ciprofloxacin for household contacts
viral causes of meningitis
enteroviruses, EBV, adenovirus and mumps
Complications of meningitis
hearing impairment
vasculitis
infarction
hydrocephalus
abscess
subdural effusion
Serious cause of encephalitis in children
HSV
Treatment of encephalitis
High dose IV acyclovir
Triad of toxic shock syndrome
- Fever >39
- hypotension
- diffuse erythematous, macular rash
Cause of toxic shock syndrome
Toxin secreting staph aureus and group A streptococci
Organ dysfunction in toxic shock syndrome
- mucositis- of the conjunctivae and the oral and genital mucosa
- GI dysfunction (D+V)
- renal impairment
- liver impairment
- clotting abnormalities and thrombocytopenia
- CNS: altered consciousness
Treatment of Toxic shock syndrome
- ICU
- antibiotics: ceftriaxone and clindamycin
- IV immunoglobulins to neutralise toxins
What asthma treatment can cause nightmares in paediatrics
Montelukast
What heart defect is common in Turner’s syndrome
Bicuspid aortic valve
What is shown on a biopsy of Hirschsprung’s disease
Absence of ganglion cells
What heart defect is common in Down’s syndrome
Atrial septal defect
What is a halo sign on x ray of the oesophagus indicate
Ingestion of a button battery - requires immediate urgent endoscopy
Management of febrile convulsion lasting > 5 mins
Buccal midazolam or rectal diazepam
Treatment of Kawasaki disease
Iv immmunoglobulins and high dose aspirin
Core feature of autism in children
Poor social interactions, narrow interests, language deficits, repetitive behaviours
What is the most common abdominal tumour in children
Wilms tumour
What are children with Down’s syndrome more likely to develop
Hirschsprung disease
What is a risk factor for pyloric stenosis
Prematurity
Signs of necrotising enterocolitis
Bilious vomiting
Bloody stools
Absent bowel sounds
Systemic compromise with metabolic acidosis
What should an 18th month old be able to do
Use a cup and spoon to feed themselves
Most common cause of late onset neonatal sepsis
Staph aureus
What is the most common cause of congenital adrenal aplasia
21 - hydroxylase deficiency
Order of management of chocking
- cough encouragements
- back slaps
- Heimlich manoeuvre
When should apgar scores be done
1 and 5 minutes post birth
What are apgar scored
A- appearance
P- pulse
G- grimace
A- activity
R- respiration
Long term complication of untreated vesicoureteric reflux
Renal scarring
Sign of intussusxupetion on ultrasound
Target sign- concentric echogenic and hypotonic bands
