Paeds Flashcards
How can Hb on capillary blood gas look in neonate ?
Hb is high in neonate and then becomes lower over time when their own bone marrow starts to kick in - physiological anaemia of newborn
What’s a newborn sepsis screen ?
Urine culture, blood culture, LP
First line sepsis Abx
Neonatal: Gentamicin and Benzyl Pen
Paeds: Cefotaxime and amoxicillin
What gives Listeria coverage?
Amoxicillin
Why would you give aciclovir in neonatal sepsis?
Herpes simplex virus -HSV1/2
Why give Vit K in neonatal sepsis ?
Baby may be bleeding somewhere
Do you treat (amount of abx) on working weight or current weight?
Working weight
(It is the birth weight until the current weight exceeds it.)
When is LP not done?
Increased or suspected increased ICP
- haemodynamically unstable
- seizures
- non- blanching rash (meningococcal sepsis)
Why is hypokalemic hypochloraemic metabolic alkalosis due to pyloric stenosis a medical emergency
Hypokalaemia- risk of arrhythmia !! Add potassium to IV fluids
How to treat pyloric stenosis ?
Pyloromyotomy
What is a low, very low, extremely low birthweight?
Low- <2.5kg
Very low-<1.5kg
Extremely-<1kg
What is a term baby ?
37-42 weeks
Post date/post term baby?
Post term- >42 weeks
Why do preterm babies get hypothermia?
High SA to volume ratio- lots of heat loss
What is surfactant made by?
Type 2 pneumocytes
What is surfactant? How does it work.
It’s a mixture of phospholipids and proteins that reduces surface tension between the gas- liquid interface
What vascular damage causes IVH?
Venous damage
What causes retinopathy of prematurity?
Abnormal blood vessel growth in the retina
How to diagnose Bronchopulmonary dysplasia ? Criteria?
Is caused by mechanical ventilation and oxygen
- required oxygen for 28 days
- if still require oxygen at 36 weeks corrected
When is magnesium sulphate given and why?
Preterm Labour <32 weeks for Neuroprotection - 30% decrease in cerebral palsy ( has to be given 24 hours before giving birth)
What can cause IVH?
- respiratory distress syndrome
- changes in blood pressure
What is a macule, papule, vesicle, petechiae, purpura, ecchymoses? What causes them?
What bacterial, viruses can cause macular rashes?
What bacterial, viruses can cause vesicular, bullous, pustular rashes?
What bacterial, viruses can cause petechiae
rashes?
Is scarlet fever a notifiable illness ?
Yes
What symptoms and signs may there be in scarlet fever?
- pharyngitis first
Fever lasts 24-48 hours - Sandpaper like, maculopapular confluent rash which starts on torso
- strawberry tongue
- pastia’s lines
- desquamination of fingers and toes
What can cause hydrops fetalis?
Immune
- haemolytic disease of newborn- ABO/rhesus D incompatibility
Non immune
- hereditary spherocytosis
- thallasaemia
Infective
- parvovirus B19
Parvovirus B19 complications
Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis
Treatment of transient aplastic crisis in Slapped cheek
Supportive mostly
What is Kawasaki disease ?
Systemic medium sized vessel vasculitis
What is the criteria for Kawasaki?
- Unexplained fever for >5 days
- 4/5 of the following for classical Kawasaki
‘crash burn’ mneumonic
Features of Kawasaki
widespread erythematous maculopapular rash
desquamation (skin peeling) on the palms and soles
Strawberry tongue (red tongue with large papillae)
Cracked lips
Cervical lymphadenopathy
Bilateral conjunctivitis
Why is Kawasaki so bad? What’s the main complication
It is a vasculitis! Can cause thrombosis and aneurysms
Main comp: coronary artery aneurysm
How to treat Kawasaki?
Kawasaki is treated by aspirin. First high dose for thrombosis prophylaxis and then low dose. What’s the low dose for?
Anti-platelet
What is Henoch - Schonlein purpura?
- IgA vasculitis -purpuric rash affects lower limbs and buttocks in children.
- Inflammation occurs in the affected organs due to IgA deposits in the blood vessels-
skin, kidneys and gastro-intestinal tract. - triggered by an upper airway infection or gastroenteritis.
4 features of HSP?
(How common)
Purpura (100%)- due to leaky capillaries
Joint pain (75%)- arthralgia and arthritis
Abdominal pain (50%)- gastrointestinal haemorrhage, intussusception and bowel infarction.
Renal involvement (50%)- haematuria and Proteinuria
Treatment and monitoring for Henoch Schonlein purpura?
Supportive - analgesia, rest, hydration
Urine dipstick monitoring for renal involvement
Blood pressure monitoring for hypertension
Do we give platelets in ITP?
No- as even if you give them they will be destroyed quickly
How much fluid can you give maximally as boluses?
40ml/kg after which they need airway support
How much fluid do you give in a bolus for children ?
10ml/kg
What is a port wine stain associated with
Sturge- Weber syndrome - neurological syndrome with increased capillaries in meninges
Early sign of Autism
Only if this carries on and is very predominant
-stimming- self-stimulatory behaviour – is repetitive body movements or noises
-walking on tip toes
- head banging
- sensory meltdowns - due to overwhelming stimuli
- lack of response to voice/sound - withdrawn
-lack of eye contact
- missing their speech milestones
-
ASD diagnosis
Investigations
- FBC (anaemia), LFTs, U&Es
- genetic screen
- DSM 5
- MDT assessments
Contraindications for ADHD stimulant medication
- family history of cardiovascular issues - arrhythmias
- family may not want the child to be on medication
What do the parents receive after diagnosis of adhd?
Links to websites about parental training
- behavioural techniques
School informed and make certain adaptations - sit at the front of class, re-direction, improving attention
Why is ASD and ADHD under diagnosed in females
Better at masking symptoms and compensating
ADHD in girls usually presents more as inattention
What is used during a ADHD assessments
- own observations as clinician - DSM-5 criteria
- Conners questionnaire - schools, home life
- QB test- tracks movements with a sensor on head, given a low stimulus environment with a screen and clicker, must click when see certain shapes on screen. Looks at their attention and movements
What are the 3rd generation cephalosporins? Why are they used for meningitis ?
Ceftriaxone, cefotaxime, ceftazidime
Cross the blood brain barrier
2 main causes for pre term birth
- infection
- cervical incompetence
Red flag for neonatal sepsis
- Chorioamnionitis
- hypothermia <36.5
-RR >60
-
Why do babies with sepsis have hypoglycaemia?
If there was a compromised labour- the baby uses all their glycogen stores
Septic babies don’t feed well
Neonatal sepsis Inx
- FBC, CRP- may be normal as can’t mount immune response
-BMs- hypoglycaemic? - CBG- lactate and acid base balance
- blood culture
-LP - CXR
How to treat neonatal sepsis ?
- O2/ventilation if needed
- Umbilical arterial lined measure BP
- central line- umbilical venous line to administer IV abx
IV abx- 7 days to 6 weeks (depends on organism and response)
- IV benzylpenecillin ( gram positive- group b strep)
-IV gentamicin ( gram negative- e.coli)
After babies been in community - IV cefotaxime and IV amoxicillin ( Neisseria, Strep pneumoniae, HiB)
Follow up on the clinic
On NIPE what makes a murmur benign and innocent?
When do neonates get prophylactic abx?
What’s a atypical paeds UTI?
- poor urine stream
- sepsis
- raised creatinine
- organism other than e.coli
- doesn’t get better within 48 hrs of abx
- Abdo or bladder mass
What’s a recurrent UTI?
- 2 or more upper UTIs
- 3 or more lower UTIs
- 1 upper and 1 lower
Signs on clinical examination of a patients resp status?
- Resp rate
- use of accessory muscles- SCM, abdominal
- Signs of resp distress- intercostal/subcostal recession or head bobbing
- abnormal airway sounds
- tracheal tugging
- nasal flaring
differentials for infant wheeze?
- Bronchiolitis
- Viral induced wheeze
- LRTI
- Foreign body inhalation
- anaphylaxis
Management of bronchiolitis ?
-Supplementary oxygen
- Upper airway secretion suction or saline nasal drops
- NG tube - if poor feeding
- Ventilation- high flow oxygen
- IV fluids
3 viruses that cause bronchiolitis?
- respiratory syncytial virus
- Influenza virus
- Adenoviruses
- parainfluenza
Differentials for petechial rash
- meningococcal sepsis
- Idiopathic thrombocytopenic purpura
- Henoch schonlein purpura
- congenital bleeding disorders
- Acute lymphoblastic leukaemia
Emergency management of meningococcal septicaemia?
- secure airway + high-flow oxygen
- IV access → take bloods and blood cultures
- IV fluid resuscitation
- IV antibiotics- IV ceftriaxone
long term complications of meningococcal sepsis
- Hearing loss
- cerebral palsy
- Seizures and epilepsy
- Cognitive impairment and learning disability
give 3 Inactivated Toxoid vaccines
Diphtheria
Tetanus
Pertussis
inactivated Conjugate
vaccines
H influenzae
Meningitis C
Meningitis ACWY
Pneumococcus
inactivated recombinant vaccines
Hepatitis B
Human Papilloma virus
Meningitis B
inactivated whole killed vaccines
Polio (IPV)
Live attenuated vaccines
Rotavirus
MMR.
Nasal flu
Shingles
Chickenpox
BCG
4 year old boy short for his age, swelling in the wrists and has this x ray - whats the diagnosis
Rickets
- cupping: concavity of metaphysis
- deficient mineralisation of the growth plate
inheritance pattern of:
- Spinal muscular Atrophy
-Duchenne muscular dystrophy
SMA- autosomal Recessive
DMD- X linked recessive
what is spinal muscular atrophy?
progressive loss of motor neurones, leading to progressive muscular weakness.
lower motor neurone signs:
-fasciculations
- reduced muscle bulk
-reduced tone,
- reduced power
-reduced or absent reflexes.
can occur in the first couple months of life
Baby vomiting since birth after all feeds, first was milky vomits and now greenish, no pyrexia and alert. whats the diagnosis ?
duodenal atresia
Bell’s palsy is a facial paralysis caused by LMN lesion, upper motor neuron lesions are more concerning. how do you distinguish between both ?
In UMN lesions that cause facial paralysis the forehead will be spared due to bi-innervation of the upper face
why would you delay giving a child the MMR vaccine ?
-severe immunosupression
- serious allergic reaction to an earlier dose of MMR vaccine
- allergy to antibiotic neomycin (component of vaccine)
Kocher criteria for septic arthritis ?
fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC
Jaundice in the first 24 hrs since birth causes?
- Haemolytic disease of the newborn
-Sepsis and disseminated intravascular coagulation - G6PD deficiency
-Extrahepatic biliary atresia
-ABO haemolytic disease
hereditary spherocytosis
What’s the most common cause of down’s syndrome
1) mosaicism
2)non disjunction
3) translocation
Non- disjunction
EEG finding of the following types of seizures:
- Infantile spasms
- Absence seizures
- Lennox-Gastaut syndrome
- Infantile spasms - hypsarrhythmia
- Absence seizures- 3Hz generalized, symmetrical
- Lennox-Gastaut syndrome- slow spike
What type of WBC is high in whooping cough-pertussis?
Lymphocytes!!!!
Kawasaki disease mneumonic (symptoms)
What are the red flags for child with fever and suspected infection ?
What features would prompt you to get a neonate assessed by the neonatal team after meconium liquor ?
respiratory rate above 60 per minute
the presence of grunting
heart rate below 100 or above 160 beats/minute
capillary refill time above 3 seconds
temperature of 38°C or above, or 37.5°C on 2 occasions 30 minutes apart
oxygen saturation below 95%
presence of central cyanosis
How is the fluid bolus for children calculated?
10ml/kg-
and same for DKA
DR RAI SAID IN REVISION session
