PAEDS Flashcards
pneumatosis intestinalis
intramural gas
continuous machinery murmur
PDA
diastolic decrescendo murmur
aortic or pulmonary regurg
mid diastolic murmur with opening click
mitral stenosis
pansystolic murmur
mitral and tricuspid regurg
ejection systolic murmur left sternal edge
pulmonary stenosis
ASD assoc w which congenital condition
downs
downs increases risk of what cancer
ALL
sarnat staging
hypoxic ischaemic encephalopathy
has 3 stages
CXR in meconium aspiration
asymmetrical patchy opacities
level of glucose concerning in neonatal hypoglycaemia
<2mmol/L
HIE cooling and warming done over how many hrs
cooling= 72 hrs
warming= 6
HIE cooling temp
33-34 degrees celsius
exchange transfusion in haemolytic disease of newborn when
bilirubin rising >8-10 per hr
anaemia, Hb <100
phototherapy refractory
IVIG in haemolytic disease of newborn when
bilirubin rising >8.5 per hr
only for immune haemolysis
glucose given in severe neonatal hypoglycaemia
2ml/kg 10% glucose bolus
3.6 ml/kg/hr 19% glucose maintenance
BG aim in neonatal hypoglycaemia
3-4 mmol/L
mx for neonatal hypoglycaemia due to hyperinsulinaemia
glucagon
diazoxide and chlorthiazide
somatostatin analogue
what time of onset and GA indicates pathological jaundice in neonate
<24 hrs birth
<35 weeks GA
what are 2 lines on normogram for jaundice and how do they guide mx
blue and red
above blue below red= phototherapy
above red = exchange transfusion
paces neonatal jaundice
explain its common
explain ix if under 1 week or over 14 days
phototherapy- safe, eyes protected, bloods taken
encourage breastfeeds
stay in after phototherapy to check for rebound hyperbilirubinaemia
type of ventilation used in neonatal RDS
CPAP
oxygen sat target in neonatal RDS
91-95%
3 medications given for toxo and their course
pyrimethamine
folinic acid
sulfadiazine
for 1 yr
when is NGT/TPN used for TTN
if resp rate >60/80
when are abx given in TTN
persists for .4-6 hrs
tracheosophaeal fistula/ oesophageal atresia type A mx
stabilisation and gastrostomy
oesophageal replacement
tracheosophaeal fistula/ oesophageal atresia type B/D mx
suction catheter
surgical correction
tracheosophaeal fistula/ oesophageal atresia type C mx
stabilisation
surgical correction
tracheosophaeal fistula/ oesophageal atresia type E mx
NBM
division of fistula
3 congential heart disease
TGA
TOF
tricuspid atresia
hyperoxia test
indicates congenital heart disease
low o2 sats in 100% oxygen for 10 mins
cause of HF in child
PDA
rheumatic fever
reasons for closing PDA
reduce risk of bacterial endocarditis
reduce risk of pulmonary vascular disease
PDA closure medications 1/2/3 line
1= indomethacin
2= prostacyclin synthetase inhibitor
3= ibuprofen (VLBW or premie)
blalock taussing shunt
for TOF
between subclavian and pulmonary artery
TOF definitive surgery done when
4 months
age children are dry by day only
4
age children are dry by day and night
5
recurrent UTI definition
2x upper UTI/pyelo
1x upper UTI/pyelo plus 1x lower UTI
3x lower UTI
red flags for constipation in children
present after birth
failure to pass meconium in 48 hrs
abdo distention and vomiting
neurological/developmental abnormality
abnormal looking anus
4 types of laxative with example of each
osmotic= lactulose, movicol
bulk forming= fybogel, cellulose
stimulant= senna
stool softner= docusate sodium
disimpaction regime for constipation
movicol titrating dose up for 2 weeks
may add senna if ineffective
complications of crohns
bloody diarrhoea
cancer
clinical dehydration and shock % weight loss
clinical dehydration= >5%
shock= >10%
3 fluid replacements
resus bolus
dehydration correction
maintenance
time frame 3 types of fluid are given over
resus- within 10 mins
dehydration correction- over 48 hrs
maintenance- 24 hrly
most accurate measure of dehydration
weight loss over course of illness
neonate fluids
day 1- 50-60ml/kg
day 2-70-80ml/kg
day 3- 80-100ml/kg
day 4-100-120 ml/kg
day 5-28- 120-150 ml/kg
fluid type used for neonates
IV crystalloid with 10% dextrose
monitoring for failure to thrive
daily= under 1 month
weekly= 1-6 months
fortnightly= 6-12 months
monthly= over 1 yr
admission for gastroenteritis when
clinically dehydrated or shocked
uncontrollable vomiting
painful bloody diarrhoea
shigella
complications like HUS/sepsis
abx in gastroenteritis when
salmonella under 6 months
immunocompromised salmonella
c diff
school exclusion gastroenteritis
48 hrs after last vomit/diarrhoea
gastroenteritis recovery
diarrhoea lasts 5-7 days should stop in 2 weeks
vomiting lasts 2-3 days should stop in a week
inguinal and umbilical hernia repair when
inguinal= based on sx
umbilical= if small and asymptomatic at 4-5 yrs, if large and symptomatic at 2-3 yrs
if incarcerated, manually reduce with pressure and emergency surgery
age infantile colic resolves by
6 months
abx for intussception
clindamycin and gentamicin
IBS medications
laxatives
anti spasmodics
antimotility- loperamide chloride
surgery for malrotation
ladds procedure
mesenteric adenitis is preceded by
a viral infection
h pylori eradication therapy
PPI
clarithromycin 500 mg
amoxicillin 1 g
all BD
what is diagnosed when endoscopy is normal and peptic ulcer disease was suspected
functional dyspepsia- upper GI variant of IBS
pyloric stenosis fluids
1.5x maintenance with 5% dextrose and 0.45% saline
pyloric stenosis surgery
ramstedt pyloromyotomy
UC complications
growth
cancer
medications for steroid dependant UC
thiopurine
infliximab
surgery for volvulus
ladds procedure
when should steroids not be used in meningitis
meningococcal septiciaemia
when should steroids be used in meningitis
purulent CSF
high WCC in CSF
high protein conc in CSF
bacteria on gram stain
EBV advice
no contact sports or heavy lifting for one month, up to 8 weeks
no school exclusion but avoid kissing and sharing utensils
no amoxicillin, ampicillin or aspirin
abx to avoid in EBV and why
amoxicillin and ampicillin
cause florid macropapular rash
medications to decreased raised ICP
corticosteroids
mannitol
HSV1/HSV2 encephalitis medication
IV aciclovir
high dose 2-3 weeks
CMV encephalitis medication
ganciclovir plus foscarnet
VZV encephalitis medication
aciclovir or ganciclovir
EBV encephalitis medication
cidofovir
ix done for paediatric red flags present in a febrile child
bloods- FBC, CRP, electrolytes
blood culture
blood gas
CXR
LP
urine test
empirical abx
where are febrile children treated/ within what timeframe if they have red flag sx
immediate transfer to a&e by ambulance if lfie threatening features
OR
face to face assessment within 2 hrs
hip US at 6 weeks when
breech presentation
even if spontaneously moved to cephalic presentation/ successful ECV
roseola infantum virus
HHV6
HHV7
vaccine not given to HIV+ve children
BCG
HIV +ve children medication
2x NRTI
parvovirus b19 infection >3weeks mx
IVIG 5 days
may need transfusion for anaemia
localised impetigo mx
hydrogen peroxide 1% cream
topical fusidic acid
widespread/ bullous impetigo mx
oral flucloxacillin
kawasaki disease mx
IVIG single dose, can repeat
high dose aspirin up to 72hrs then low dose for 8 weeks
severe malaria mx
parenteral artesunate
measles school exclusion
4 days after rash onset
measles complication
otitis media (most common)
pneumonia
encephalitis
measles mx
supportive
vit A for 2 days
mumps school exclusion
5 days after parotitis develops
who do you notify in notifiable disease
local health protection unit
public health england
rubella school exclusion
5 days after rash onset
rubella advice
stay away from pregnant women
vaccination if not
abx for TSS
clindamycin plus penicillin usually
typhoid abx
ciprofloxacin
add azithromycin
ADHD first line mx
watch and wait for 10 weeks
ADHD focused group training programme
ADHD monitor height
every 6 months
ADHD monitor weight
every 3 months
ADHD medications
methylphenidate
lisdexamphetamine
dexamphetamine
guanfacine
always 6 week trial to start
monitor ECG
document for children with learning difficulties
EHC plan: education, health and care
what age do breath holding attacks resolve by
4-5
breath holding attack differential
anaemia- check FBC
what age should a child sit by
8 months
what age should a child walk by
18 months
medications for cerebral palsy
stiffness= baclofen
drooling= anticholinergic
constipation= laxative
sleeping= melatonin
medications for duchennes muscular dystrophy
glucocorticoids
nocturnal CPAP
ataluren
discontinue antiepileptics in children when they havent had a seizure for
2 yrs
tonic clonic seizure first line anti epileptic
sodium valproate
absence seizure first line anti epileptic
ethosuximide
focal seizure first line anti epileptic
levitiracetam or lamotrigine
myoclonic seizure first line anti epileptic
valproate or lamotrigine
driving is allowed in epilepsy when you havent had a seizure for
1 yr
age for febrile convulsions
6months-6yrs
advice during seizure
cushion head
dont put anything in mouth
remove harmful objects
advice after seizure
check airway
put in recovery position
recurrence rate of febrile convulsions
1/3
preventing febrile seizure advice
immunise even if it was after an im
reducing fever doesnt change risk of recurrence
use paracetamol or ibuprofen when febrile
hydrate child well
headache urgent neuro assessment if under what age
4 yrs
headache red flags
present in morning
wakes them up at night
worse on bending down, sneezing or coughing
ataxia
meningism
new onset focal deficit
squinting or cant look up
vomiting
changes in levels of consciousness
worsens
hydrocephalus mx
ventriculoperitoneal shunt
medication for myotonia in muscular dystrophy
mexelitine
phenytoin dose in status
20mg/kg infusion over 20 mins
what should you think when you see subdural haematoma
NAI- must be considered/ruled out
DKA glucose, ketones and blood pH
glucose >11
ketones >3 or +++
pH <7.3
which fluids are used in DKA
0.9% saline only until glucose <14
0.9% saline plus 5% glucose when glucose <14
all fluids should have 40mmol/L potassium chloride added
mild/moderate/severe DKA ranges
mild= pH 7.2-7.29
moderate= pH 7.1-7.19
severe= pH <7.1
fluid deficit in mild/moderate/severe DKA
mild= 5%
moderate= 7%
severe= 10%
insulin dose/started when in DKA
1-2 hrs after fluid therapy
0.05-0.1 units/kg/hr
what is done with long acting insulin for a child with DKA
continued throughout treatment
insulin therapies for T1DM
mutiple daily injections w basal bolus regime
continuous subcut pump
glucose targets T1DM fasting and after meals
fasting= 4-7
after meals= 5-9
hba1c target T1DM
<48
CBG monitoring T1DM
5x daily
diabetes complication monitoring regime for children
nephropathy/retinopathy/ hypertension annually from 12 onwards
thyroid function from diagnosis anually
hyperthyroid medication
carbimazole or propylthiouracil
carbimazole/propylthiouracil side effecs
neutropenia
go to hospital if they have a sore throat
medications given in anaphylaxis
adrenaline 1:1000
chlorphenamine 10mg
hydrocortisone 200mg
specific things to look for in skin/mouth anaphylaxis
urticaria
angioedema
sepsis what level of lactate is high risk
> 2
pulses to check for circulation in children
femoral
radial
brachial
sepsis abx
IV ceftriaxone
under 3 months add ampillicin/amox for listeria
neonate <72hrs benzylpenicillin and gentamicin
sepsis lactate levels and fluids
> 4= give fluids, consider ionotropes and vaspressors
2-4= give fluids
<2= consider fluids
what BG to treat neonatal hypoglycaemia
<1
gastroenteritis in children most common organism
rotavirus
induction chemo for ALL
prednisolone
vincristine
anthracyclines
(if no CNA involvement)
if CNS involvement= give intrathecal chemo too (triple therapy)
prophylactic drugs given in ALL
abx
antiviral
antifungals
haemopoeitic factors for febrile neutropenia
drug given in philadelphia chromosome +ve ALL patients
tyrosine kinase inhibitors- imatinib
hodgkins lymphoma chem regime
ABVD
2 cycles if favorable disease
4 cycles if non favorable or BEACOPP followed by 2x ABVD and radiotherapy
relapse ALL mx
high dose chemo
bone marrow transplant
medications for tumor lysis prevention
rasbicurase or allopurinol
retinoblastoma common age of presentation
18 months
retinoblastoma how is treatment guided
is gross vitreous seeding present: cells floating in vitreous humor
what type of tumor is wilms tumor
nephroblastoma
egg on side appearance of heart shadow
TGA
TGA mx
prostaglandin E1 to maintain PDA
balloon atrial septostomy
difference in timing of presentation between TOF and TGA
TGA= immediately at birth
TOF= 1-2 months, up to 6 months
whats the diff between viral induced wheeze and croup
viral wheeze= wheeze, responsive to salbutamol
croup= stridor, not responsive to salbutamol
orkambi is used to treat and comprises
CF with delta F508 mutation
lumacaftor/ivacaftor
chromosome for beta thalassaemia mutation
11
beta thalassaemia mx
blood transfusions plus desferroxamine
common cause of DIC
sepsis
medication do not give in DIC
antithrombin
platelet disorder characteristics
superficial bleeding (skin, gums, nose)
petechiae
immediately after surgery
after cuts/scratches
mild
coagulation factor disorder characteristics
deep bleeding (haemarthrosis)
no petechaie
delayed bleeding after surgery, not after cuts/scratches
severe
how to replace platelets
platelet transfusion
how to replace coagulation factors
FFP
signs of acute haemoylsis
jaundice
pallor
dark urine
condition fava bans avoided in
G6PD deficiency
in haemophilia and vWD avoid
IM injections
aspirin
NSAIDs
difference between thalassaemia and haemophilia
thalassaemia= deficient alpha or beta globin production
haemophillia= deficiency of factor 8 or 9
medication given in haemophilia A to induce factor 8 and vWF release
desmopressin
complications of haemophilia treatment
antibodies to factor 8/9
tranfusion related infections
veins
parvovirus B complication
aplastic crisis
chronic ITP mx
mycophenolate mofetil
rituximab
eltrombopag
ferrrous sulphate continue for how long once IDA corrected
3 months
FBC checked how long after starting ferrous sulphate in IDA
2-4 weeks
should rise by 2g/100 mL over 4 weeks
if rising normally check again at 2-4 months
day to day mx of sickle cell
immunise against encapsulated organisms
daily folic acid
daily penicillin
avoid stress (cold, dehydration, hypoxia, excessive exercise)
hydroxycarbamide (if >3 admissions in a year)
mx of acute sickle cell crisis
oral/IV analgesia
IV fluids
abx if infection
exchange transfusion if acute chest syndrome/priapism/stroke
side effect of desmopressin in vWD
hyponatraemia
position leg is in in split/pavlik harness
flexed
abducted
follow up how long after split/pavlik harness
6 months
US 6 weeks for DDH when
breech at any point
family hx
imaging for DDH after 6 weeks
x ray
better than US
admit all children with what fracture
femoral shaft
observation for DDH until what age
6 months
JIA mx by what team
paediatric rheumatology MDT
what is osgood schlatter disease
swelling and inflammation at growth plate at top of shin bone
ergocalciferol
vit D2
cholecalciferol
vit D3
pseudo vitamin D deficiency is caused by
defect in 1 alpha hydroxylase
mx with calcitriol
septic arthritis abx
IV 2 weeks then oral 4 weeks
<3 months= IV cefotaxime
3 months -5 years= IV ceftriaxone
over 6 yrs= IV flucloxacillin
if allergic to penicillin= clindamycin
oral step down= co amox and fluclox
trethowans sign
line of klein doesnt intersect upper femoral epiphysis or there is asymmetry between either side
seen in SUFE
surgical repair for SUFE
in situ screw fixation across growth plates
best marker of liver failure
PT
mx of acute liver failure
prevent hypoglycaemia: IV dextrose
prevent cerebral oedema: fluid restrict and mannitol diuresis
prevent bleeding= IV vit K and H2 antagonists
PSC mx
ursodeoxycholic acid
autoimmune hep mx
prednisolone
azothioprine
biliary atresia mx
kasai procedure within 60 days of life
transplant if refractory
also give: fat soluble vitamins, prophylactic abx for one yr, ursodeoxycholic acid to promote bile flow if needed
ascites mx
sodium and fluid restriction
drainage
of refractory albumin infusion
babies born to mums w hep B are given
vaccination and immunoglobulin
acute otitis media mx
conservative
if abx needed amoxicillin 5-7 days
acute epiglottitis mx
ceftriaxone when intubated
co amox when stable
acute epiglottitis household prophylaxis
rifampicin
plan everyone with asthma should have
personalised asthma action plan
how is blue inhaler used
up to 10 puffs every 30-60 seconds
SABA nebs dose for asthma attack
5mg >5yrs
2.5mg 2-5 yrs
o2 sats target acute asthma attack
> 94%
ipatropium bromide nebs dose for asthma attack
1-11yrs: 250mcg every 20-30 mins first 2 hrs then every 4-6 hrs
12-17yrs: 500mcg every 4-6hrs
prednisolone dose acute asthma attack
1-2mg/kg/day
40mg max
asthma attack follow up within what time
48hrs of presentation if not admitted
2 working days of discharge if admitted
mag sulf nebs dose astham attack
150mg
gold standard ix for bronchiectasis diagnosis
high resolution CT
signet ring sign on high resolution CT
bronchiectasis
when diameter of bronchus is bigger than bronchial artery
CF bronchiectasis organism
pseudomonas
non CF bronchiectasis acute exacerbation mx
airway clearance w saline
abx
bronchiolitis prophylaxis when high risk
pavilizumab
IgE vs non IgE mediated cows milk protein allergy
IgE mediated= onset within 2 hrs of ingestion
not IgE mediated= onset within 2-72 hrs of ingestion
dex dose croup
0.15mg/kg
what are recessions
skin between the ribs pulling in between every breath
medications for CF
CFTR modulators: kaftrio if over 2, funding now stopped
mucolytics: rhDNAse, hyeprtonic saline, dry mannitol inhalation
pancreatic enzyme replacement: creon
if liver disease: ursodeoxycholic acid
prophylactic abx for pseudomonas in CF
azithromycin
GS diagnosis for food allergy
food challenge
what ages can you do heimlich manouvre
> 1
high pitched inspiratory stridor worse when lying flat or exertion
laryngomalacia
abx for paediatric pneumonia
moderate= amoxicillin (clarith if allergic)
severe= co amoxiclav (clarith if severe)
scarlet fever abx
phenoxymethylpenicillin QDS 10 days
scarlet fever complications
acute glomerulonephritis
rheumatic fever
scarlet fever school exclusion
until 24 hrs after abx
scores for sore throat giving abx
feverPAIN
centor
abx given when centor score is
3 or 4
whooping cough abx
<1 month= clarithromycin
>1 month= axithromycin
give if presenting within 21 days of cough onset
what age are all those with whooping cough admitted
<6 months
whooping cough school exclusion
until 48hrs after abx started
until 21 days after cough onset if abx not given
where a competent child refuses treatment
a person w parental responsibility or the court can authorise investigation or treatment if in the childs best interests
family law reform act
those over 16 can consent to treatment
those under 18 cannot refuse treatment unless one parent agrees with them (even if other parent diagrees)
MMR contraix
dont get pregnant for 1 month
IgG therapy past 3 months
infant who has had another live vaccine in past 4 weeks
severe immunosupression
allergic to neomycin
who to get involved for NAI
senior colleague
named doctor for child protection
consider involving police (CAIT= child abuse investigation team)
consider involving MASH (multi agency safeguarding hub)
ix for NAI
skeletal survey
MRI/CT head
bloods
bone profile
opthalmology referral (fundoscopy for retinal haemorrhages)
counselling for NAI
I am going to speak to you about the next steps for your child medically and non medically
Medically we would like to do these ix
Non medically, we are not sure how this injury has occurred, because of this we would like to admit your child
Sometimes, when injuries like this present they do not happen by accident and are caused by someone else
When this happens, we have to routinely involve some teams including social services, the child safeguarding team and maybe the police
Our aim is to keep your child safe
school exclusion for 24 hrs after abx start
scarlet fever
school exclusion for 48 hrs after abx start
whooping cough
school exclusion for 5 days after parotitis
mumps
school exclusion until rash crusts over
impetigo
VZV
school exclusion for 4 days from rash onset
measles
rubella
school exclusion until treated
scabies
school exclusion until recovered
influenza
school exclusion until sx settled for 48 hrs
diarrhoea/vomitting
normal resp rate
<1
1-5
5-12
>12
<1= 30-40
1-5= 20-30
5-12= 15-20
>12= 12-16 (adult)
normal HR
<1
1-5
5-12
>12
<1= 110-160
1-5= 95-140
5-12= 80-120
>12= 60-100 (adult)
normal systolic BP
<1
1-5
5-12
>12
<1= 70-90
1-5= 80-100
5-12= 90-110
>12= 100-120 (adult)
clinically dehydrated (5%) fluid mx
continue milk
oral rehydration solution 50ml/kg over 4 hrs plus maintenance fluids
clinically shocked (>10% dehydration) mx
iv fluid bolus 0.9% saline 10ml/kg
when resolved IV 0.9% saline 100ml/kg over 4 hrs plus maintenance
maintenence fluids infusion rate
first 10 kg
second 10 kg
anything over 20kg
first 10 kg= 4ml/kg/hr
second 10 kg= 2ml/kg/hr
anything over 20kg= 1ml/kg/hr
vaccines given at 8 weeks
6 in 1
rotavirus
men B
vaccines given at 12 weeks
6 in 1
rotavirus
PCV
vaccines given at 16 weeks
6 in 1
men B
vaccines given at 1 yr
Hib/men C
men B
PCV
MMR
vaccines given at 2yrs annually
nasal flu
vaccines given at 3yrs 4 months
4 in 1 preschool booster
MMR
vaccines given at 12-13yrs
HPV
vaccines given at 14 yrs
3 in 1 teenage booster
men ACWY
whats in 6 in 1 vaccine
diptheria
pertussis
polio
tetanus
HIB
Hep B
whats in 4 in 1 vaccine
diptheria
tetanus
pertussis
polio
whats in 3 in 1 vaccine
diptheria
polio
tetanus
cellulitis vs erysipelas
mx for both
erysipelas= very well demarcated, mx with penicillin v
cellulitis= oral flucoxacillin if severe otherwise conservative mx
what infection causes aplastic crisis in sickle cell
erythema infectiosum
edwards syndrome karyotype
trisomy 18