PAEDS Flashcards
1
Q
pneumatosis intestinalis
A
intramural gas
2
Q
continuous machinery murmur
A
PDA
3
Q
diastolic decrescendo murmur
A
aortic or pulmonary regurg
4
Q
mid diastolic murmur with opening click
A
mitral stenosis
5
Q
pansystolic murmur
A
mitral and tricuspid regurg
6
Q
ejection systolic murmur left sternal edge
A
pulmonary stenosis
7
Q
ASD assoc w which congenital condition
A
downs
8
Q
downs increases risk of what cancer
A
ALL
9
Q
sarnat staging
A
hypoxic ischaemic encephalopathy
has 3 stages
10
Q
CXR in meconium aspiration
A
asymmetrical patchy opacities
11
Q
level of glucose concerning in neonatal hypoglycaemia
A
<2mmol/L
12
Q
HIE cooling and warming done over how many hrs
A
cooling= 72 hrs
warming= 6
13
Q
HIE cooling temp
A
33-34 degrees celsius
14
Q
exchange transfusion in haemolytic disease of newborn when
A
bilirubin rising >8-10 per hr
anaemia, Hb <100
phototherapy refractory
15
Q
IVIG in haemolytic disease of newborn when
A
bilirubin rising >8.5 per hr
only for immune haemolysis
16
Q
glucose given in severe neonatal hypoglycaemia
A
2ml/kg 10% glucose bolus
3.6 ml/kg/hr 19% glucose maintenance
17
Q
BG aim in neonatal hypoglycaemia
A
3-4 mmol/L
18
Q
mx for neonatal hypoglycaemia due to hyperinsulinaemia
A
glucagon
diazoxide and chlorthiazide
somatostatin analogue
19
Q
what time of onset and GA indicates pathological jaundice in neonate
A
<24 hrs birth
<35 weeks GA
20
Q
what are 2 lines on normogram for jaundice and how do they guide mx
A
blue and red
above blue below red= phototherapy
above red = exchange transfusion
21
Q
paces neonatal jaundice
A
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
22
Q
type of ventilation used in neonatal RDS
A
CPAP
23
Q
oxygen sat target in neonatal RDS
A
91-95%
24
Q
3 medications given for toxo and their course
A
pyrimethamine
folinic acid
sulfadiazine
for 1 yr
25
when is NGT/TPN used for TTN
if resp rate >60/80
26
when are abx given in TTN
persists for .4-6 hrs
27
tracheosophaeal fistula/ oesophageal atresia type A mx
stabilisation and gastrostomy
oesophageal replacement
28
tracheosophaeal fistula/ oesophageal atresia type B/D mx
suction catheter
surgical correction
29
tracheosophaeal fistula/ oesophageal atresia type C mx
stabilisation
surgical correction
30
tracheosophaeal fistula/ oesophageal atresia type E mx
NBM
division of fistula
31
3 congential heart disease
TGA
TOF
tricuspid atresia
32
hyperoxia test
indicates congenital heart disease
low o2 sats in 100% oxygen for 10 mins
33
cause of HF in child
PDA
rheumatic fever
34
reasons for closing PDA
reduce risk of bacterial endocarditis
reduce risk of pulmonary vascular disease
35
PDA closure medications 1/2/3 line
1= indomethacin
2= prostacyclin synthetase inhibitor
3= ibuprofen (VLBW or premie)
36
blalock taussing shunt
for TOF
between subclavian and pulmonary artery
37
TOF definitive surgery done when
4 months
38
age children are dry by day only
4
39
age children are dry by day and night
5
40
recurrent UTI definition
2x upper UTI/pyelo
1x upper UTI/pyelo plus 1x lower UTI
3x lower UTI
41
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
42
4 types of laxative with example of each
osmotic= lactulose, movicol
bulk forming= fybogel, cellulose
stimulant= senna
stool softner= docusate sodium
43
disimpaction regime for constipation
movicol titrating dose up for 2 weeks
may add senna if ineffective
44
complications of crohns
bloody diarrhoea
cancer
45
clinical dehydration and shock % weight loss
clinical dehydration= >5%
shock= >10%
46
3 fluid replacements
resus bolus
dehydration correction
maintenance
47
time frame 3 types of fluid are given over
resus- within 10 mins
dehydration correction- over 48 hrs
maintenance- 24 hrly
48
most accurate measure of dehydration
weight loss over course of illness
49
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
50
fluid type used for neonates
IV crystalloid with 10% dextrose
51
monitoring for failure to thrive
daily= under 1 month
weekly= 1-6 months
fortnightly= 6-12 months
monthly= over 1 yr
52
admission for gastroenteritis when
clinically dehydrated or shocked
uncontrollable vomiting
painful bloody diarrhoea
shigella
complications like HUS/sepsis
53
abx in gastroenteritis when
salmonella under 6 months
immunocompromised salmonella
c diff
54
school exclusion gastroenteritis
48 hrs after last vomit/diarrhoea
55
gastroenteritis recovery
diarrhoea lasts 5-7 days should stop in 2 weeks
vomiting lasts 2-3 days should stop in a week
56
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
57
age infantile colic resolves by
6 months
58
abx for intussception
clindamycin and gentamicin
59
IBS medications
laxatives
anti spasmodics
antimotility- loperamide chloride
60
surgery for malrotation
ladds procedure
61
mesenteric adenitis is preceded by
a viral infection
62
h pylori eradication therapy
PPI
clarithromycin 500 mg
amoxicillin 1 g
all BD
63
what is diagnosed when endoscopy is normal and peptic ulcer disease was suspected
functional dyspepsia- upper GI variant of IBS
64
pyloric stenosis fluids
1.5x maintenance with 5% dextrose and 0.45% saline
65
pyloric stenosis surgery
ramstedt pyloromyotomy
66
UC complications
growth
cancer
67
medications for steroid dependant UC
thiopurine
infliximab
68
surgery for volvulus
ladds procedure
69
when should steroids not be used in meningitis
meningococcal septiciaemia
70
when should steroids be used in meningitis
purulent CSF
high WCC in CSF
high protein conc in CSF
bacteria on gram stain
71
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
72
abx to avoid in EBV and why
amoxicillin and ampicillin
cause florid macropapular rash
73
medications to decreased raised ICP
corticosteroids
mannitol
74
HSV1/HSV2 encephalitis medication
IV aciclovir
high dose 2-3 weeks
75
CMV encephalitis medication
ganciclovir plus foscarnet
76
VZV encephalitis medication
aciclovir or ganciclovir
77
EBV encephalitis medication
cidofovir
78
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
79
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
80
hip US at 6 weeks when
breech presentation
even if spontaneously moved to cephalic presentation/ successful ECV
81
roseola infantum virus
HHV6
HHV7
82
vaccine not given to HIV+ve children
BCG
83
HIV +ve children medication
2x NRTI
84
parvovirus b19 infection >3weeks mx
IVIG 5 days
may need transfusion for anaemia
85
localised impetigo mx
hydrogen peroxide 1% cream
topical fusidic acid
86
widespread/ bullous impetigo mx
oral flucloxacillin
87
kawasaki disease mx
IVIG single dose, can repeat
high dose aspirin up to 72hrs then low dose for 8 weeks
88
severe malaria mx
parenteral artesunate
89
measles school exclusion
4 days after rash onset
90
measles complication
otitis media (most common)
pneumonia
encephalitis
91
measles mx
supportive
vit A for 2 days
92
mumps school exclusion
5 days after parotitis develops
93
who do you notify in notifiable disease
local health protection unit
public health england
94
rubella school exclusion
5 days after rash onset
95
rubella advice
stay away from pregnant women
vaccination if not
96
abx for TSS
clindamycin plus penicillin usually
97
typhoid abx
ciprofloxacin
add azithromycin
98
ADHD first line mx
watch and wait for 10 weeks
ADHD focused group training programme
99
ADHD monitor height
every 6 months
100
ADHD monitor weight
every 3 months
101
ADHD medications
methylphenidate
lisdexamphetamine
dexamphetamine
guanfacine
always 6 week trial to start
monitor ECG
102
document for children with learning difficulties
EHC plan: education, health and care
103
what age do breath holding attacks resolve by
4-5
104
breath holding attack differential
anaemia- check FBC
105
what age should a child sit by
8 months
106
what age should a child walk by
18 months
107
medications for cerebral palsy
stiffness= baclofen
drooling= anticholinergic
constipation= laxative
sleeping= melatonin
108
medications for duchennes muscular dystrophy
glucocorticoids
nocturnal CPAP
ataluren
109
discontinue antiepileptics in children when they havent had a seizure for
2 yrs
110
tonic clonic seizure first line anti epileptic
sodium valproate
111
absence seizure first line anti epileptic
ethosuximide
112
focal seizure first line anti epileptic
levitiracetam or lamotrigine
113
myoclonic seizure first line anti epileptic
valproate or lamotrigine
114
driving is allowed in epilepsy when you havent had a seizure for
1 yr
115
age for febrile convulsions
6months-6yrs
116
advice during seizure
cushion head
dont put anything in mouth
remove harmful objects
117
advice after seizure
check airway
put in recovery position
118
recurrence rate of febrile convulsions
1/3
119
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
120
headache urgent neuro assessment if under what age
4 yrs
121
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
122
hydrocephalus mx
ventriculoperitoneal shunt
123
medication for myotonia in muscular dystrophy
mexelitine
124
phenytoin dose in status
20mg/kg infusion over 20 mins
125
what should you think when you see subdural haematoma
NAI- must be considered/ruled out
126
DKA glucose, ketones and blood pH
glucose >11
ketones >3 or +++
pH <7.3
127
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
128
mild/moderate/severe DKA ranges
mild= pH 7.2-7.29
moderate= pH 7.1-7.19
severe= pH <7.1
129
fluid deficit in mild/moderate/severe DKA
mild= 5%
moderate= 7%
severe= 10%
130
insulin dose/started when in DKA
1-2 hrs after fluid therapy
0.05-0.1 units/kg/hr
131
what is done with long acting insulin for a child with DKA
continued throughout treatment
132
insulin therapies for T1DM
mutiple daily injections w basal bolus regime
continuous subcut pump
133
glucose targets T1DM fasting and after meals
fasting= 4-7
after meals= 5-9
134
hba1c target T1DM
<48
135
CBG monitoring T1DM
5x daily
136
diabetes complication monitoring regime for children
nephropathy/retinopathy/ hypertension annually from 12 onwards
thyroid function from diagnosis anually
137
hyperthyroid medication
carbimazole or propylthiouracil
138
carbimazole/propylthiouracil side effecs
neutropenia
go to hospital if they have a sore throat
139
medications given in anaphylaxis
adrenaline 1:1000
chlorphenamine 10mg
hydrocortisone 200mg
140
specific things to look for in skin/mouth anaphylaxis
urticaria
angioedema
141
sepsis what level of lactate is high risk
>2
142
pulses to check for circulation in children
femoral
radial
brachial
143
sepsis abx
IV ceftriaxone
under 3 months add ampillicin/amox for listeria
neonate <72hrs benzylpenicillin and gentamicin
144
sepsis lactate levels and fluids
>4= give fluids, consider ionotropes and vaspressors
2-4= give fluids
<2= consider fluids
145
what BG to treat neonatal hypoglycaemia
<1
146
gastroenteritis in children most common organism
rotavirus
147
induction chemo for ALL
prednisolone
vincristine
anthracyclines
(if no CNA involvement)
if CNS involvement= give intrathecal chemo too (triple therapy)
148
prophylactic drugs given in ALL
abx
antiviral
antifungals
haemopoeitic factors for febrile neutropenia
149
drug given in philadelphia chromosome +ve ALL patients
tyrosine kinase inhibitors- imatinib
150
hodgkins lymphoma chem regime
ABVD
2 cycles if favorable disease
4 cycles if non favorable or BEACOPP followed by 2x ABVD and radiotherapy
151
relapse ALL mx
high dose chemo
bone marrow transplant
152
medications for tumor lysis prevention
rasbicurase or allopurinol
153
retinoblastoma common age of presentation
18 months
154
retinoblastoma how is treatment guided
is gross vitreous seeding present: cells floating in vitreous humor
155
what type of tumor is wilms tumor
nephroblastoma
156
egg on side appearance of heart shadow
TGA
157
TGA mx
prostaglandin E1 to maintain PDA
balloon atrial septostomy
158
difference in timing of presentation between TOF and TGA
TGA= immediately at birth
TOF= 1-2 months, up to 6 months
159
whats the diff between viral induced wheeze and croup
viral wheeze= wheeze, responsive to salbutamol
croup= stridor, not responsive to salbutamol
160
orkambi is used to treat and comprises
CF with delta F508 mutation
lumacaftor/ivacaftor
161
chromosome for beta thalassaemia mutation
11
162
beta thalassaemia mx
blood transfusions plus desferroxamine
163
common cause of DIC
sepsis
164
medication do not give in DIC
antithrombin
165
platelet disorder characteristics
superficial bleeding (skin, gums, nose)
petechiae
immediately after surgery
after cuts/scratches
mild
166
coagulation factor disorder characteristics
deep bleeding (haemarthrosis)
no petechaie
delayed bleeding after surgery, not after cuts/scratches
severe
167
how to replace platelets
platelet transfusion
168
how to replace coagulation factors
FFP
169
signs of acute haemoylsis
jaundice
pallor
dark urine
170
condition fava bans avoided in
G6PD deficiency
171
in haemophilia and vWD avoid
IM injections
aspirin
NSAIDs
172
difference between thalassaemia and haemophilia
thalassaemia= deficient alpha or beta globin production
haemophillia= deficiency of factor 8 or 9
173
medication given in haemophilia A to induce factor 8 and vWF release
desmopressin
174
complications of haemophilia treatment
antibodies to factor 8/9
tranfusion related infections
veins
175
parvovirus B complication
aplastic crisis
176
chronic ITP mx
mycophenolate mofetil
rituximab
eltrombopag
177
ferrrous sulphate continue for how long once IDA corrected
3 months
178
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
179
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)
180
mx of acute sickle cell crisis
oral/IV analgesia
IV fluids
abx if infection
exchange transfusion if acute chest syndrome/priapism/stroke
181
side effect of desmopressin in vWD
hyponatraemia
182
position leg is in in split/pavlik harness
flexed
abducted
183
follow up how long after split/pavlik harness
6 months
184
US 6 weeks for DDH when
breech at any point
family hx
185
imaging for DDH after 6 weeks
x ray
better than US
186
admit all children with what fracture
femoral shaft
187
observation for DDH until what age
6 months
188
JIA mx by what team
paediatric rheumatology MDT
189
what is osgood schlatter disease
swelling and inflammation at growth plate at top of shin bone
190
ergocalciferol
vit D2
191
cholecalciferol
vit D3
192
pseudo vitamin D deficiency is caused by
defect in 1 alpha hydroxylase
mx with calcitriol
193
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
194
trethowans sign
line of klein doesnt intersect upper femoral epiphysis or there is asymmetry between either side
seen in SUFE
195
surgical repair for SUFE
in situ screw fixation across growth plates
196
best marker of liver failure
PT
197
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
198
PSC mx
ursodeoxycholic acid
199
autoimmune hep mx
prednisolone
azothioprine
200
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
201
ascites mx
sodium and fluid restriction
drainage
of refractory albumin infusion
202
babies born to mums w hep B are given
vaccination and immunoglobulin
203
acute otitis media mx
conservative
if abx needed amoxicillin 5-7 days
204
acute epiglottitis mx
ceftriaxone when intubated
co amox when stable
205
acute epiglottitis household prophylaxis
rifampicin
206
plan everyone with asthma should have
personalised asthma action plan
207
how is blue inhaler used
up to 10 puffs every 30-60 seconds
208
SABA nebs dose for asthma attack
5mg >5yrs
2.5mg 2-5 yrs
209
o2 sats target acute asthma attack
>94%
210
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
211
prednisolone dose acute asthma attack
1-2mg/kg/day
40mg max
212
asthma attack follow up within what time
48hrs of presentation if not admitted
2 working days of discharge if admitted
213
mag sulf nebs dose astham attack
150mg
214
gold standard ix for bronchiectasis diagnosis
high resolution CT
215
signet ring sign on high resolution CT
bronchiectasis
when diameter of bronchus is bigger than bronchial artery
216
CF bronchiectasis organism
pseudomonas
217
non CF bronchiectasis acute exacerbation mx
airway clearance w saline
abx
218
bronchiolitis prophylaxis when high risk
pavilizumab
219
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
220
dex dose croup
0.15mg/kg
221
what are recessions
skin between the ribs pulling in between every breath
222
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
223
prophylactic abx for pseudomonas in CF
azithromycin
224
GS diagnosis for food allergy
food challenge
225
what ages can you do heimlich manouvre
>1
226
high pitched inspiratory stridor worse when lying flat or exertion
laryngomalacia
227
abx for paediatric pneumonia
moderate= amoxicillin (clarith if allergic)
severe= co amoxiclav (clarith if severe)
228
scarlet fever abx
phenoxymethylpenicillin QDS 10 days
229
scarlet fever complications
acute glomerulonephritis
rheumatic fever
230
scarlet fever school exclusion
until 24 hrs after abx
231
scores for sore throat giving abx
feverPAIN
centor
232
abx given when centor score is
3 or 4
233
whooping cough abx
<1 month= clarithromycin
>1 month= axithromycin
give if presenting within 21 days of cough onset
234
what age are all those with whooping cough admitted
<6 months
235
whooping cough school exclusion
until 48hrs after abx started
until 21 days after cough onset if abx not given
236
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
237
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)
238
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
239
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)
240
ix for NAI
skeletal survey
MRI/CT head
bloods
bone profile
opthalmology referral (fundoscopy for retinal haemorrhages)
241
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
242
school exclusion for 24 hrs after abx start
scarlet fever
243
school exclusion for 48 hrs after abx start
whooping cough
244
school exclusion for 5 days after parotitis
mumps
245
school exclusion until rash crusts over
impetigo
VZV
246
school exclusion for 4 days from rash onset
measles
rubella
247
school exclusion until treated
scabies
248
school exclusion until recovered
influenza
249
school exclusion until sx settled for 48 hrs
diarrhoea/vomitting
250
normal resp rate
<1
1-5
5-12
>12
<1= 30-40
1-5= 20-30
5-12= 15-20
>12= 12-16 (adult)
251
normal HR
<1
1-5
5-12
>12
<1= 110-160
1-5= 95-140
5-12= 80-120
>12= 60-100 (adult)
251
normal systolic BP
<1
1-5
5-12
>12
<1= 70-90
1-5= 80-100
5-12= 90-110
>12= 100-120 (adult)
252
clinically dehydrated (5%) fluid mx
continue milk
oral rehydration solution 50ml/kg over 4 hrs plus maintenance fluids
253
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
254
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
255
vaccines given at 8 weeks
6 in 1
rotavirus
men B
256
vaccines given at 12 weeks
6 in 1
rotavirus
PCV
257
vaccines given at 16 weeks
6 in 1
men B
258
vaccines given at 1 yr
Hib/men C
men B
PCV
MMR
259
vaccines given at 2yrs annually
nasal flu
260
vaccines given at 3yrs 4 months
4 in 1 preschool booster
MMR
261
vaccines given at 12-13yrs
HPV
262
vaccines given at 14 yrs
3 in 1 teenage booster
men ACWY
263
whats in 6 in 1 vaccine
diptheria
pertussis
polio
tetanus
HIB
Hep B
264
whats in 4 in 1 vaccine
diptheria
tetanus
pertussis
polio
265
whats in 3 in 1 vaccine
diptheria
polio
tetanus
266
cellulitis vs erysipelas
mx for both
erysipelas= very well demarcated, mx with penicillin v
cellulitis= oral flucoxacillin if severe otherwise conservative mx
267
what infection causes aplastic crisis in sickle cell
erythema infectiosum
268
edwards syndrome karyotype
trisomy 18
269
