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Y4 Zuzi extras > Paeds > Flashcards

Paeds Flashcards

1
Q

How can Hb on capillary blood gas look in neonate ?

A

Hb is high in neonate and then becomes lower over time when their own bone marrow starts to kick in - physiological anaemia of newborn

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2
Q

What’s a newborn sepsis screen ?

A

Urine culture, blood culture, LP

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3
Q

First line sepsis Abx

A

Neonatal: Gentamicin and Benzyl Pen
Paeds: Cefotaxime and amoxicillin

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4
Q

What gives Listeria coverage?

A

Amoxicillin

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5
Q

Why would you give aciclovir in neonatal sepsis?

A

Herpes simplex virus -HSV1/2

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6
Q

Why give Vit K in neonatal sepsis ?

A

Baby may be bleeding somewhere

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7
Q

Do you treat (amount of abx) on working weight or current weight?

A

Working weight
(It is the birth weight until the current weight exceeds it.)

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8
Q

When is LP not done?

A

Increased or suspected increased ICP
- haemodynamically unstable
- seizures
- non- blanching rash (meningococcal sepsis)

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9
Q

Why is hypokalemic hypochloraemic metabolic alkalosis due to pyloric stenosis a medical emergency

A

Hypokalaemia- risk of arrhythmia !! Add potassium to IV fluids

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10
Q

How to treat pyloric stenosis ?

A

Pyloromyotomy

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11
Q

What is a low, very low, extremely low birthweight?

A

Low- <2.5kg
Very low-<1.5kg
Extremely-<1kg

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12
Q

What is a term baby ?

A

37-42 weeks

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13
Q

Post date/post term baby?

A

Post term- >42 weeks

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14
Q

Why do preterm babies get hypothermia?

A

High SA to volume ratio- lots of heat loss

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15
Q

What is surfactant made by?

A

Type 2 pneumocytes

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16
Q

What is surfactant? How does it work.

A

It’s a mixture of phospholipids and proteins that reduces surface tension between the gas- liquid interface

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17
Q

What vascular damage causes IVH?

A

Venous damage

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18
Q

What causes retinopathy of prematurity?

A

Abnormal blood vessel growth in the retina

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19
Q

How to diagnose Bronchopulmonary dysplasia ? Criteria?

A

Is caused by mechanical ventilation and oxygen
- required oxygen for 28 days
- if still require oxygen at 36 weeks corrected

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20
Q

When is magnesium sulphate given and why?

A

Preterm Labour <32 weeks for Neuroprotection - 30% decrease in cerebral palsy ( has to be given 24 hours before giving birth)

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21
Q

What can cause IVH?

A
  • respiratory distress syndrome
  • changes in blood pressure
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22
Q

What is a macule, papule, vesicle, petechiae, purpura, ecchymoses? What causes them?

A
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23
Q

What bacterial, viruses can cause macular rashes?

A
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24
Q

What bacterial, viruses can cause vesicular, bullous, pustular rashes?

A
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25
Q

What bacterial, viruses can cause petechiae
rashes?

A
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26
Q

Is scarlet fever a notifiable illness ?

A

Yes

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27
Q

What symptoms and signs may there be in scarlet fever?

A
  • 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
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28
Q

What can cause hydrops fetalis?

A

Immune
- haemolytic disease of newborn- ABO/rhesus D incompatibility
Non immune
- hereditary spherocytosis
- thallasaemia
Infective
- parvovirus B19

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29
Q

Parvovirus B19 complications

A

Aplastic anaemia
Encephalitis or meningitis
Pregnancy complications including fetal death
Rarely hepatitis, myocarditis or nephritis

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30
Q

Treatment of transient aplastic crisis in Slapped cheek

A

Supportive mostly

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31
Q

What is Kawasaki disease ?

A

Systemic medium sized vessel vasculitis

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32
Q

What is the criteria for Kawasaki?

A
  1. Unexplained fever for >5 days
  2. 4/5 of the following for classical Kawasaki
    ‘crash burn’ mneumonic
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33
Q

Features of Kawasaki

A

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

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34
Q

Why is Kawasaki so bad? What’s the main complication

A

It is a vasculitis! Can cause thrombosis and aneurysms
Main comp: coronary artery aneurysm

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35
Q

How to treat Kawasaki?

A
36
Q

Kawasaki is treated by aspirin. First high dose for thrombosis prophylaxis and then low dose. What’s the low dose for?

A

Anti-platelet

37
Q

What is Henoch - Schonlein purpura?

A
  • 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.
38
Q

4 features of HSP?

A

(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

39
Q

Treatment and monitoring for Henoch Schonlein purpura?

A

Supportive - analgesia, rest, hydration

Urine dipstick monitoring for renal involvement
Blood pressure monitoring for hypertension

40
Q

Do we give platelets in ITP?

A

No- as even if you give them they will be destroyed quickly

41
Q

How much fluid can you give maximally as boluses?

A

40ml/kg after which they need airway support

42
Q

How much fluid do you give in a bolus for children ?

A

10ml/kg

43
Q

What is a port wine stain associated with

A

Sturge- Weber syndrome - neurological syndrome with increased capillaries in meninges

44
Q

Early sign of Autism

A

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
-

45
Q

ASD diagnosis

A

Investigations
- FBC (anaemia), LFTs, U&Es
- genetic screen

  • DSM 5
  • MDT assessments
46
Q

Contraindications for ADHD stimulant medication

A
  • family history of cardiovascular issues - arrhythmias
  • family may not want the child to be on medication
47
Q

What do the parents receive after diagnosis of adhd?

A

Links to websites about parental training
- behavioural techniques
School informed and make certain adaptations - sit at the front of class, re-direction, improving attention

48
Q

Why is ASD and ADHD under diagnosed in females

A

Better at masking symptoms and compensating
ADHD in girls usually presents more as inattention

49
Q

What is used during a ADHD assessments

A
  • 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
50
Q

What are the 3rd generation cephalosporins? Why are they used for meningitis ?

A

Ceftriaxone, cefotaxime, ceftazidime

Cross the blood brain barrier

51
Q

2 main causes for pre term birth

A
  • infection
  • cervical incompetence
52
Q

Red flag for neonatal sepsis

A
  • Chorioamnionitis
  • hypothermia <36.5
    -RR >60
    -
53
Q

Why do babies with sepsis have hypoglycaemia?

A

If there was a compromised labour- the baby uses all their glycogen stores
Septic babies don’t feed well

54
Q

Neonatal sepsis Inx

A
  • FBC, CRP- may be normal as can’t mount immune response
    -BMs- hypoglycaemic?
  • CBG- lactate and acid base balance
  • blood culture
    -LP
  • CXR
55
Q

How to treat neonatal sepsis ?

A
  • 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

56
Q

On NIPE what makes a murmur benign and innocent?

A
57
Q

When do neonates get prophylactic abx?

A
58
Q

What’s a atypical paeds UTI?

A
  • poor urine stream
  • sepsis
  • raised creatinine
  • organism other than e.coli
  • doesn’t get better within 48 hrs of abx
  • Abdo or bladder mass
59
Q

What’s a recurrent UTI?

A
  • 2 or more upper UTIs
  • 3 or more lower UTIs
  • 1 upper and 1 lower
60
Q

Signs on clinical examination of a patients resp status?

A
  • 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
61
Q

differentials for infant wheeze?

A
  • Bronchiolitis
  • Viral induced wheeze
  • LRTI
  • Foreign body inhalation
  • anaphylaxis
62
Q

Management of bronchiolitis ?

A

-Supplementary oxygen
- Upper airway secretion suction or saline nasal drops
- NG tube - if poor feeding
- Ventilation- high flow oxygen
- IV fluids

63
Q

3 viruses that cause bronchiolitis?

A
  • respiratory syncytial virus
  • Influenza virus
  • Adenoviruses
  • parainfluenza
64
Q

Differentials for petechial rash

A
  • meningococcal sepsis
  • Idiopathic thrombocytopenic purpura
  • Henoch schonlein purpura
  • congenital bleeding disorders
  • Acute lymphoblastic leukaemia
65
Q

Emergency management of meningococcal septicaemia?

A
  • secure airway + high-flow oxygen
  • IV access → take bloods and blood cultures
  • IV fluid resuscitation
  • IV antibiotics- IV ceftriaxone
66
Q

long term complications of meningococcal sepsis

A
  • Hearing loss
  • cerebral palsy
  • Seizures and epilepsy
  • Cognitive impairment and learning disability
67
Q

give 3 Inactivated Toxoid vaccines

A

Diphtheria
Tetanus
Pertussis

68
Q

inactivated Conjugate
vaccines

A

H influenzae
Meningitis C
Meningitis ACWY
Pneumococcus

69
Q

inactivated recombinant vaccines

A

Hepatitis B
Human Papilloma virus
Meningitis B

70
Q

inactivated whole killed vaccines

A

Polio (IPV)

71
Q

Live attenuated vaccines

A

Rotavirus
MMR.
Nasal flu
Shingles
Chickenpox
BCG

72
Q

4 year old boy short for his age, swelling in the wrists and has this x ray - whats the diagnosis

A

Rickets
- cupping: concavity of metaphysis
- deficient mineralisation of the growth plate

73
Q

inheritance pattern of:
- Spinal muscular Atrophy
-Duchenne muscular dystrophy

A

SMA- autosomal Recessive
DMD- X linked recessive

74
Q

what is spinal muscular atrophy?

A

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

75
Q

Baby vomiting since birth after all feeds, first was milky vomits and now greenish, no pyrexia and alert. whats the diagnosis ?

A

duodenal atresia

76
Q

Bell’s palsy is a facial paralysis caused by LMN lesion, upper motor neuron lesions are more concerning. how do you distinguish between both ?

A

In UMN lesions that cause facial paralysis the forehead will be spared due to bi-innervation of the upper face

77
Q

why would you delay giving a child the MMR vaccine ?

A

-severe immunosupression
- serious allergic reaction to an earlier dose of MMR vaccine
- allergy to antibiotic neomycin (component of vaccine)

78
Q

Kocher criteria for septic arthritis ?

A

fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC

79
Q

Jaundice in the first 24 hrs since birth causes?

A
  • Haemolytic disease of the newborn
    -Sepsis and disseminated intravascular coagulation
  • G6PD deficiency
    -Extrahepatic biliary atresia
    -ABO haemolytic disease
    hereditary spherocytosis
80
Q

What’s the most common cause of down’s syndrome
1) mosaicism
2)non disjunction
3) translocation

A

Non- disjunction

81
Q

EEG finding of the following types of seizures:
- Infantile spasms
- Absence seizures
- Lennox-Gastaut syndrome

A
  • Infantile spasms - hypsarrhythmia
  • Absence seizures- 3Hz generalized, symmetrical
  • Lennox-Gastaut syndrome- slow spike
82
Q

What type of WBC is high in whooping cough-pertussis?

A

Lymphocytes!!!!

83
Q

Kawasaki disease mneumonic (symptoms)

A
84
Q

What are the red flags for child with fever and suspected infection ?

A
85
Q

What features would prompt you to get a neonate assessed by the neonatal team after meconium liquor ?

A

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

86
Q

How is the fluid bolus for children calculated?

A

10ml/kg-
and same for DKA
DR RAI SAID IN REVISION session

87
Q
A

Y4 Zuzi extras (8 decks)

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