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finals > Paeds > Flashcards

Paeds Flashcards

1
Q

What to check at well child visit

A

vaccinations
growing ie head lenght wt
abuse/neglect
development milestones

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2
Q

Failure to thrive organic reasons

A

genetic ie CF
heart disease
pyloric stenosis
GORD

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3
Q

Developmental milestones gross motor

2mo
4mo
6mo

1yr
2yr
3yr
4yr
5yr

A

lift head
roll over
sit up

walk
steps
tricycle
hop
skip

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4
Q

Developmental milestones fine motor

3yr
4yr
5yr

A

circle
cross
triangle

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5
Q

Developmental milestones social

6 weeks
6mo

1yr

A

social smile

stranger anxiety

1 year separation anxiety

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6
Q

path of acute allergic reaction

A

IGE-mediated type 1 hypersen

trigger = cross linking of mast cells which degranulate = histamine release

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7
Q

anaphylaxis presentation n tx

A

urticaria (rash)
hypotension
wheeze

from trigger

remove cause
adrenaline IM 0.5ml 1:1000
fluids
chlorphenamine IV
steroids

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8
Q

Urticaria presentation n tx

A

wheal
whelt
erythema

No hypotension

check not anaphylaxis
Self limiting
non sedating anti hist ie loratidine,cetrizine

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9
Q

angioedema present n mx

A

swelling all over but esp airway
post acei
no rash no hypotension

secure airway
anti hist
steroids

if c1 esterase deficiency = give FFP

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10
Q

allergic rhinitis presentation n mx

A

shiners (runny eyes)
Salute sign (pushing nose up to wipe)
Pale boggy mucosa
nasal polyps
cobblestining bc post nasal drip

avoid trigger
intranasal steroids

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11
Q

Allergic conjuctiv present n mx

A

shiners runny eyes
conjunct injection
chemosis (swelling)

h2 antihisatmines
LTA

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12
Q

Food allergies cause n presentation n management

A

wheat soy milk eggs
Nuts shellfish (anaphylaxis)

N&V&D
and associated with atopic dermatitis

Clx dx but maybe foot trial to narrow down trigger

tx avoid trigger and carry epi pen if anaphylaxis

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13
Q

Tx for milk protein allergy

n cause

A

MC cause soy formula

tx cows milk
breatfeed
hydrolysed formula

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14
Q

What is BRUE

A

brief resolved unexplained event

<1yo + <1min duration of;

change in;
colour
tone
breathing
responsiveness

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15
Q

Low risk Brue criteria

A

Age
term baby> 60 days
pre term >32GA or >45Post conception

No hx to suggest any of causes
no physical findings
no cpr for episode
1st time episode

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16
Q

Things that might want to rule out w brue

A

gord
LRTI
seizure (eye move.jerk)

sepsis (fever)
heart disease (FTT &murmur)
abuse (mult injuries)

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17
Q

SIDS prevention

A

sleep on back (flattens occiput)

dont share bed

smoking cessation

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18
Q

vaccine CI egg allergy

A

yellow fever

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19
Q

Vaccines CI if immunocomp

A

Live attenuated ie

MMRV
influenza if live (intranasal) - (IM Flu is ok)

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20
Q

Mom hep B +ve (chronic or acute during preg)

baby mx?

A

Hep B vaccine course now

+ Hep B ig

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21
Q

DTaP vaccine schedule

A

5 doses
3x in 1st year, 1x 3-5, 1x 13-18

2mo,3mo,4mo

3-5yrs

13-18yrs

= full lifetime course

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22
Q

wound
pt had full tetanus course
last dose<10yrs

A

regardless of would severity

no vaccine
no tet immunoglob(Tig)

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23
Q

Pt full course of tetanus vaccines last dose >10 years

A

Tetanus prone wound (dirty) = Vaccine booster?

High risk would ie
compound frac, delayed surg intervention , large degree devitalised tissue = vaccine boost + Tig

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24
Q

unknown tetanus hx

A

vaccine booster

if high risk/tetanus prone would = also Tig

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25
Q

hiB vacciine for

A

epiglottisis

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26
Q

mmrv course and CI

A

12-15mo

3-4years

CI pregnanct women severe immunocomp ie transplant, AIDs, biologics

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27
Q

Tetanus presentation

how does Vaccine n Tig work

tx

A

dirty wound, lockjaw, spasms
lethal dose <immune response

TIG - block toxin
Vaccine (toxoid ie looks like tet)

Tx intubate, sedate , muscle relaxer, metronidazole

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28
Q

Diptheria presentation n mx

A

High fever, sob, dysphagia
grey pseudomembranious in oropharynx (do not touch)

secure airway, abx, antitoxin

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29
Q

Pertussis presentation 3 phases

Tx

A

vague catarrhal stage -infectious days of rinorhea, cough and low grade fever

Paraxysmal phase - coughiing spells interspersed with insp. whoop

Resolution phase

supportive ie secure airway if need
erythromcin Iv abx

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30
Q

Common cause of otitis externa

A

swimmers ear

pseudomonas
staph. aureus

seb dermatitis (fungal)
contact dermatitis (allergiccor irritatnt)

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31
Q

Otitus media causing bugs

presentation and Dx

A

Resp bugs - strep.pneum, h.influ, moraxella

painful ear - relief on tugging

Pneumatic insufflation ie air on eardrum = stiff

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32
Q

common cold causing pathogen

A

rhinovirus

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33
Q

choanal atresia

A

connection between mouth and nose

Unilat and bi(emergency)

Blue baby at rest (nose breather ie breastfeeding)
Pink when crying

catheter cant get through if complete atresia

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34
Q

erthyema infectiosum

virus

pt:

tx
complications

A

PARVOVIRUS 19

‘slapped cheek’
fever and rash

supportive

aplastic crisis in sickle cell thalasemia and sperocytosis
hydrops fetalis

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35
Q

time off school slapped cheek

A

infectious for 10 days before rash so once it comes no time off

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36
Q

roseola infantum virus

A

HHV 6

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37
Q

roseola infantum sx

tx and comps

A

High fever then rash AFter fever

Starts on trunk and spreads outwards

supportive tx

febrile seizures

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38
Q

measles prodrome

and spread

A

4 Cs

cough
corzya
conjunctivitus
Coplik spots (white small spots in mouth)

fever and rash

spreads from face (behind ears ) to whole body inc palms n soles

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38
Q

measles virus

A

paramyxovirus

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39
Q

later in life complication of measles

A

subacute sclerosing panencephalitis

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40
Q

rubella prodrome

and spread

A

generalised tender lymphadenopathy

fever and macular rash from face spread to trunk
itchy

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41
Q

measles infectious period

A

4 days before and after rash

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42
Q

rubela infecious spread

A

7 days before and after sx

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43
Q

varicella zoster sx

A

rash

difuse vesicles on erthyematous base
diff stages of healing

NO fever

starts on head back trunk then peripheries

44
Q

varicella zoster (VZV) infectious period

A

2 days before and 5 days after sx start which is usually when lesions crust over

45
Q

mumps

presentation

complication

A

pubertal males
parotiditis
orchiditis

infertility

46
Q

hand foot and mouth disease

virus and presentation

A

coxsackie a16

vesicular rash on mouth (1st) then feet and hand

47
Q

Kochers criteria

A

Septic arthritis in kids

48
Q

sickle cell path

A

glutamate swapped for valine 6th space on chromosome 16

49
Q

definitive ddx sickle cell

A

HB electrophoresis

50
Q

sickle cell crisis mx

A

opiates
iv fluids
oxygen
abx if infection
blood transfusion

51
Q

when to use exchange transfusion sickle cell

A

neuro
acute chest ie chest pain sob pul. oedema

52
Q

sickle cell crisis prophylaxis

A

hydroxyurea

pneum vaccine every 5 yrs

53
Q

check if pt in sickle crisis

A

change from their baseline

low hb
higher bili
higher retic count
pain
sickle cells on smear

54
Q

what can happen with transfusion in sickle pt

A

iron overload = give deferoxamine

55
Q

chronic consequences of sickle

A

too much haemolysis

= chronic anaemia -> kidney release epo -> bone marrow constantly stimulated to make more RBCs = inc retic count

= high levels of unconjugated bilirubin -> pigmented gallstones & jaundice (cholecyst)

organ autoinfarct ie spleen, avascular necrosis of hip, brain lungs etc

risk of osteomyelitis

56
Q

MC cause osteomyelitis

A

staph aureus

57
Q

pt osteomyelitis with salmonella organism

A

= pt has sickle cell

58
Q

Aplastic crisis

A

sudden drop in hb post parvovirus

pancytopenia but mostly Hb

59
Q

meconium ileus in cystic fibrosis presentation and findings

A

no bowel movement since birth
distended abdo

abdo XR - dilated bowel loops proximal to an impaction
rectal biopsy negative

60
Q

cystic fibrosis fx

A

short stature
Diabetes
delayed puberty
rectal prolapse (bulky stools)
nasal polyps
male infert, female subfert

61
Q

uni undescended testes at birth

bilateral

A

review at 3mths if persist - refer

review senior paeditrician in 24hrs

62
Q

whooping cough tx

A

azithromycin/clarithromycin if cough within 21 days

63
Q

Tetralogy of fallot (TOF) features

what determines degree of cyanosis and clinical severity

A

VSD
Right vent hypertrophy
right vent outflow obstruction - pulmonary stenosis
Overriding Aorta

severity of right ventricular outflow obstruction ie pul stenosis

64
Q

Croup
cause
age group and
diagnosis/ xray

A

viral - parainfluenza
3mo-3yrs

dx = clx

Xray
PA= steeple sign
lateral = thumb sign

65
Q

Steeple sign on xray

A

subglottic narrowing

66
Q

Thumb sign on xray

A

swelling of epiglottis

67
Q

Bacterial tracheitis
cause
presenttaion
mx

A

staph aureus MC post viral URTI bc mucosal damage and local immune changes

Stridor
high fever
purulent secretions
musosal necrsis and sloughing

Iv abx

68
Q

Retropharyngeal abscess defining features

A

anterior chain unilateral lymph nodes
tender neck mass

69
Q

peritonsillar abscess defining features

A

uvular deviation to unaffected side

70
Q

foreign body airway obstruction (FBAO) extrathoracic

A

inspiratory stridor

71
Q

foreign body airway obstruction intrathoracic

A

exp wheeze

72
Q

FBAO xray findings

A

-ve coin sign AP
+coin sign lateral

= in trachea

73
Q

bronchiolitis bug and presentation

A

RSV

<2 yo
coryzal sx precede
wheeze
SOB
cough
feeding difficulties

sx peak 3-4 days

74
Q

cystic fibrosis pneumonia bug

and pancreas mx

A

pseudomonas

pancreatic enzyme supplements with meals
vitamins ADEK

75
Q

NEC pt & sign

A

premature bby
xray = peumatosis intestinalis

76
Q

intussusception age, ix, mx

A

3months- 3 years

USS = target sign

tx = air enema

surgery if peritonitis, perforation, or enema fail

77
Q

meckels diverticulum presntation ddx and tx

A

vitelline duct remenant

painless GI bright red bleeding

ddx = technicium -99 scna

tx = resection

78
Q

indicator of cerebral palsy

A

Not sitting by 8 months (corrected for gestational age)
Not walking by 18 months (corrected for gestational age)
Early asymmetry of hand function (hand preference) before 1 year (corrected for gestational age)
Persistent toe-walking

79
Q

school exclusion rubella

A

5 days onset of rash

80
Q

school exclusion scarlet fever

A

24hrs after startiing abx

81
Q

school exclusion whooping cough

A

2 days after abx
or 21 days from sx starting if no abx

82
Q

school exclusion measles

A

4 days from onset of rash

83
Q

school exclusion chickepox

A

all lesions crutsed over

84
Q

school exclusion mumps

A

5 days from onset of swollen glands

85
Q

school exclusion gastroentritis

A

48hrs sx settles

86
Q

school exclusion impetigo

A

until lesions crusted and healed

or started 48hrs since starting abx

87
Q

recurrent febrile seizures management

A

Rectal diazepam
buccal midazolam

88
Q

cystic fibrosis homoozygous for delta F508 mutation tx

A

lumacaftor/Ivacaftor (Orkambi)

89
Q

threadworm organism

A

enterobius vermicularis

90
Q

chronic management of CF

A

chest physio and postural drainage twice a day
high calorie diet including high fat intake

91
Q

fever traffic light system red

A

colour - pale, mottled, ashen, blue

activity - appears ill to professional, no response social cues, doest wake when aroused, weak high pitches continuous cry

resp - grunting, RR>60, mod/sev chest indrawing

circ - reduced skin turgor

other = age <3 w temp>38

92
Q

peads bls

A

5 rescue breaths
15 compressions (rate 100-120permin) : 2 breaths

depth of compressions = 1/3 of the chest

93
Q

stills disease

A

systemic juvenile arthritis

subtle salmon pink rash
high swinging fevers
enlarged LN
weight loss
joint inflammation
splenomegaly
muscle pain
pleurtitis
pericarditis

raised inflam markers

94
Q

stills disease complications

A

macrophage activation syndrome (MAS)
ie kid with DIC and low ESR

95
Q

which JIA may have +ve ANA

A

oligoarticular JIA

RF -ve in JIA

96
Q

chicken pox medication CI

A

NSAIDs increase risk of necrotising faciitis in pt w chicken pox

97
Q

whooping cough tx

A

macrolide ie azithromycin

98
Q

what age should stop having febrile seizures

A

usually lasts happens from 6mths to 5 years

99
Q

klumpke paralyisis

A

damage to t1
due to traction

loss of intrinsic hand muscles (thmb adductions and finger abduction)
and sensory loss over medical epicondyle

100
Q

bronchiolitis ix

A

nasopharyngeal asp

immunofloresence shows rsv

101
Q

bronchiolitis refereal to hosp criteria

A

apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.

102
Q

bronchiolitis mx in hosp

A

o2
nasal suction
ng feeing

103
Q

bronchiolitis on chest xr

A

hyperinflation

104
Q

croup sx

A

barking cough
hoarseness
stridor

105
Q

croup causes

A

parainfluenza

rsv
measles
influenza a n b

106
Q

croup differentials

A

acute epiglottitis,
bacterial tracheitis,
peritonsillar abscess
foreign body inhalation

107
Q

croup who to admit

A

moderate or severe croup
< 3 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis
(important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

108
Q
A

finals (28 decks)

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