Paeds Flashcards
(82 cards)
1
Q
list 6 causes for stridor
A
- croup
- laryngomalacia
- epiglotitis
- laryngeal FB
- retropharyngeal abscess
- bacterial tracheitis
2
Q
What are the indications for intbation in croup
A
exahustion
T2rf
T1RF
decreased consciouness and cant protect airway
imminent airway obstruction
3
Q
What are the steps for managing laryngospasm
A
4
Q
analgesia options and side effects
A
5
Q
What are the diagnostic criteria for Kawasaki Disease
A
Fever + 4
6
Q
what are the key investigations and why in ?kawasaki?
A
- ECHO - ?CA aneurysm, effusions, MR regurg. now and in 8 weeks
- cultures/strep serology or measles PCR - look for causative agent
- FBC - ?thrombocytosis - common in week 2 of disease
- ECG - long PR
7
Q
Treatment for Kawasaki
A
- IV Igs 2g/kg over 10 hours
- aspirin 3-5mg/kg for 8 weeks
- steroids
- pandaol, fluid, fibrinolytics
8
Q
what are the common causes of bowel obstruction in children under 5
A
- intersuscception
- incarcerated inguinal hernia
- malrotation of gut with volvulus
- adhesions post surgery
- annular pancreas
9
Q
what are the common causitive agents for bronchiolitis?
A
- RSV
- parainfluenza
- human metapneumovirus
- rhinovirus
10
Q
what clinical features warrant admission for bronchiolitis
A
poor feeding
apneoic episodes
markedly tachypnoeic
sats under 90
11
Q
A
12
Q
what factors increase risk of apnoea in bronchiolitis
A
low birth weight
premature
under 3 months old
immunodeficient
comorbidities
13
Q
moderate V severe bronchiolitis
A
Moderate
feeding over 50%
SOB on feeding
moderate WOB
sats under 94
lethargy
mild dehydration
Severe
poor feeding
apneoic episodes
markedly tachypnoeic
sats under 90
severe dehydration
14
Q
differential diagnosis for bronchiolitis and descriminatory finding
A
- bacterial pneumonia - one sided creps, signs of sepsis
- cardiac failure - murmur, hepatomegalt
15
Q
what criteria need to be met for discharging bronchiolitis
A
- parents happy
- sats over 93/94
- feeding close to normal
- no apnoea
- normal behaviour
- normal WOB
16
Q
characteristic examination finding of bronchiolitis
A
widespread coarse crackles to the midzone
17
Q
initial management of severe bronchiolitis
A
- High flow nasal prongs: 2L/Kg, titrate fiO2 for SpO2 94-98%
- NGT placement v IV for hydration
- Admission under paediatrics
18
Q
what is the criteria for a BRUE (Brief resolved unexplained event)
A
- it is unexpected changes in breathing
less than 1 year old
* less than a minute but usually 20-30 seconds
* return to normal baseline
* no obvious medical cause
* central cyanosis +/- absent or irregular breathing
19
Q
What are the features of a low risk BRUE
A
- no concerning exam featurs
- over 60 days old
- born over 32 weeks and corrected gestaional over 45
- no CPR but trained healthcare professional
- first event
- under 1 minutes long
20
Q
differentials for BRUE
A
Resp - inhaled FB
Cardiac - CHD or prolonged QT
neuro - head injury or seizure
abdo - intersuscception
Injury - shaken baby, OD
Metabolic - hypoglycaemia, hypocalcaemia
21
Q
what are the indications for admission with BRUE?
A
- Post-conception age <48 weeks
- Ill appearing or concerning findings on examination
- Bronchiolitis or Pertussis with apnoea
- Suspicion of non-accidental trauma
- Past medical history that places them at risk for poor outcomes
- Prolonged central apnoea or more than 1 episode in 24 hours
- Family history of SIDS or multiple BRUEs
- Poor follow-up
- Parental concern/anxiety
22
Q
A
23
Q
what are three non duct dependant causes of neonatal cardiac disease
A
TOF
VSD
ASD
trucus arteriosis
remember
arrthymias
cardiomyopathy
24
Q
what endocrine issues can cause neonatal collapse
A
- congenitial adrenal hyperplasia
- addisons
- electrolyte disturbance
25
abx duration for pneumonia
3-5 days
26
# w
what are the possible reasons for recurrent pneumonia in children?
recurrent re-infection
bronchiectasis
inhaled FB
CF
immunedeficiency
27
what further investigations would you do for recurrent chest infections?
FBC
Igs
sweat test
CT chest
bronchoscopy
28
features and most likely diagnosis
Features
* discrete lesions of various sizes
* purpura
* ?brusing
* across foot and distal leg
Most likley diagnosis
HSP
29
what are the categories of dehydration severity
30
31
what clinical signs should be monitored during rehydration?
weight
urine output
CRT
HR
ongoing losses
signs of overload
32
what congenital syndromes are associated with neonatal bowel obstruction?
CF
Downs
33
A 36 hour old neonate presents with a community nurse because of failure to pass
meconium. There has been mucous-like vomiting but the neonate otherwise looks well.
(a) A normal digital rectal examination excludes which diagnosis?
(b) The successful passage of an NG tube excludes which diagnosis?
(c) What is the characteristic X-ray appearance of duodenal atresia?
(a) A normal digital rectal examination excludes which diagnosis?
**Imperforate anus**
(b) The successful passage of an NG tube excludes which diagnosis?
**Oesophageal atresia**
(c) What is the characteristic X-ray appearance of duodenal atresia?
**Double bubble sign**
34
what are the non congentital causes of neonatal bowel obstruction
gastric volvulus
duodenal web
intersusccpetion
meconium ileus
NEC
tumour
Adhesions
Hernia
35
febrile convulsion
36
fracture with suspected NAI
Management
* analgesia
* plaster or reduction
* admit
Explain to parents
* notify child services
37
what examination features of a child would indicate a LP?
1. bulging fontanelle
2. irritable and unconsolable
3. neck stiffness
4. petichial non blanching rash
5. photophobia
6. no other source
38
what features need to be met for safe discharge of a child with a fever
1. follow up within 24 hours
2. sensible parents
3. proximity to hospital and ability to return
4. looks well
5. previously healthy
6. urine clear
7. cxr clear
8. LP normal
9. bloods unremarkable
39
40
what can neonatal jaundice cause if left untreated?
what are the complications?
**kernicterus **- chronic bilirubin encephalopathy
Complications
* Acute - seizures and coma
* chronic - cerebral palsy, developmental delay, death
41
what are the benign and pathological causes of neonatal jaundice?
**Benign**
* breast milk jaundice
* normal physiological jaundice due to immature hepatocytes
**Pathological**
* Sepsis
* haemolysis (rhesus, ABO)
* liver trouble - hepatitis, biliary atresia
* bowel obstruction
* hypothyroidism
42
how can serum bilirubin help with assessment of neonatal jaundice?
* higher total level the greater the risk
* conjugated worse as indicates obstructive cause
43
44
what are the maternal and neonatal risk factors for significant hyperbilirubinaema?
**maternal**
* Blood group and ABO incompatibility
* previous neonatal jaudice
* poorly controlled diabetes
* FH - G6PD/heriditary spherocytosis
**Neonatal**
* poor feeding
* GI - bowel obstruction, biliary atresia
* haem - polycytheamia
* sepsis
45
neonatal jaundice
46
what are the indications for bloods on a kit with gastro
* renal disease
* diuretic use
* altered conscious state
* profuse loss
* ileostony
* ?sepsis
* prolonged symptoms
* hypoglycaemia
47
what clinical signs indicate severe dehydration
* altered conscious state
* CRT over 4 seconds
* sunken eyes
* dry mucous membranes
* reduced urine output
48
causes of a generalised seziure in a child
**hypoglycaemia**
hypoxia
febrile illness
head trauma
toxins
49
child seizure
50
define syncope
abrupt loss of consciousness and postural tone from transient global hypoperfusion followed by spontaenous complete recovery
51
what is the most common cause of syncope in children
what syncope is unique to preschool
vasovagal
breath holding
52
what are the red flag features of paediatric syncope
1. syncope during exercise
2. chest pain prior
3. sob prior
4. palpitations prior
5. FH sudden cardiac death
6. known structural heart disease
53
what paediatric syncope, what conditions do you look to rule out on an ECG
1. HOCM
2. brugada
3. Long QT
4. short QT
5. WPW
6. AVRD
54
55
unwell kid
describe and interpret
RUL collapse/consolidation
LUL consolidation
NG in not far enough
pneumonia or bronchiolitis with collapse
56
laryngoscope size for kids
newborn - miller 0
to 2 years - miller 1
to 6 years - miller 2
to 12 - miller 3
over 12 - mac3
57
# k
key features and diagnosis
Features
distressed infant
erythema to face torso and limbs
desquamation to various parts
no mucous membrane involvement
**Stap scolded skin syndrome**
58
* Asthma - FH, nocturnal cough, atopy
* Infection eg RSV - fever, runny nose, looks unwell
* inhaled FB - sudden, choking, missing toy
* allergic reaction - known allergy, associated rash
* cardiac failure- known cardiac disease, oedema, FTT
* reflux, difficuluty feeding, bad breath, worse post food
59
what are the tests for CAH?
serum cortisol (LOW) and 17 hydroxyprogesterone (ELEVATED)
plasma renin and ACTH
60
what is the treatment for a baby with CAH?
* 10% dextrose 2-5mls/kg
* IV fluids – 10mls/kg
* FIRST LINE Steroids – stress hydrocortisone 25mg initially then 5-10 mg 6 hourly
Extra
Mineralocoricoid replacement - Fludrocortisone 0.05-0.1 mg
daily
61
desribe rash and diagnosis
causes
treatment
erythematous, raised plaques, confluent, target sign =** Erythema multiforme**
**Causes**
*Infection* - HSV 1 and 2, mycoplasma, VZV, adenovirus
*Drugs *- NSAIDS, penicillins
no specific treatment
62
sore throat and rash
describe rash
diagnosis
erythematous, widespread, macular
Scarlet fever - group a strep
dd:
measles
kawasaki
rubella
drug eruption
63
what is the treatment for scarlet fever
penicillin
64
what are the complications of scarlet fever
* Renal failure
*** Rheumatic heart disease**
* Abscess – peritonsillar or retropharyngeal
* Bacteraemia/ Sepsis
* Pneumonia
* Hepatitis
65
what causes a blistering rash in children
* staph scolded skin syndrome
* SJS/TEN
* bullous impetigo
66
why do you get the following in DKA
* low Na
* Low Cl
* high K
* low Na - dilutional due to hyperglycaemia
* Low Cl - loss from kidneys to maintain electrucal neutrality due to ketones and into cells
* high K - due to acidosis to maintain electromeutraility as H goes intracelluar
67
what investigations may you do in a child with first time DKA
Serum ketone finger prick – in DKA to monitor response to treatment with serial measures
UEC – assess for pre-renal renal failure with DKA
look for precipitating factor;
Urine – for UTI in febrile / urinary symptoms, CXR – assess for pneumonia if respiratory symptoms present
CT head – if signs of cerebral oedema eg reduced LOC
68
what are the obstructive and non obstructive causes of neonatal vomiting
Obstructive
* Obstructed hernia
* Necrotising enterocolitis
* Biliary atresia
* midgut volvulus
* pyloric stenosis
Non-obstructive
* Acute gastroenteritis
* Sepsis
* Inborn errors of metabolism
* Non-accidental injury (space occupying lesion e.g. SDH)
69
causes of paediatric anaemia and findings on film/FBC
* Iron Deficiency – microcytic, hypochromic; target cells, pencil cells
* Acute Leukaemia – blasts on film
* Aplastic Anaemia – low reticulocyte count
* GIT bleed (ie Meckel’s diverticulum) – elevated reticulocytes
* Haemoglobinopathy ie thalassaemia – nucleated RBCs, microcytes
* Congenital Haemolysis ie sickle cell disease sickle cells
* Acquired Haemolysis ie HUS/TTP – schistocytes, red cell fragments
* Abnormal red cells – ie spherocytosis - spherocytes
70
what are the measles specific features of history and exam
History
Rash day 3-5 of fever
starts on face
unimmunised/contact history
Exam
Kopliks spots
conjunctival injection
coryza
71
management of measles
● tell public health
Check rest of family – contact and immunisation status / offer MMR/IG where appropriate
● History - Check for any pregnant staff / high risk contacts
● High risk contacts may need to be admitted and treated in a single room with Measles IG
● Notify staff who had contact with patient- immunisation if required/Staff Health/Infection
control . Ensure we have all the appropriate contact numbers for family and staff
● Educate staff- patient should not have been in W/R, should have had resp isolation
● Advice to family about isolation - four days after rash appears
● Advice to family about how to get help after they leave the ED today
Supportive - analgesia and fluids
72
what is the test for measles
IgM/IgG serology
Nasal PCR
73
what are the risk factors for post natal depression
history of depression
previous post partum depression
history of mental illness
lack of social support
unwanted pregnancy
complicated birth
feeding difficulties
baby has special needs
74
what are the indicators for admission to hospital with post natal depression
psychosis
thoughts of self harm
thoughts of infant harm
any suicidality
poor social support
75
how can you estimate gestiational age?
* enquire about LMP
* fundal height umbi at 20 weeks xiphsternum at 36
* Ultrasound measures eg femur length
76
clinical signs of a duct dependant lesion
Treatment
cyanosis/hypoxia
no femoral pulses
hepatomegaly
murmur
**Treatment**
prostaglanding infusion NB apnoea
100ng/kg/min
77
dose and side effects of second line asthma treatment
78
what are the potential complications of intubating a child with asthma
tension pneumothorax
barotrauma
hypotension
cardiac arrest
79
Duct dependent v independent
80
Formula for dehydration
Normal weight - illness weight) / normal weight x100 = percentage loss
81
rash for rheumatic fever
erythema marginatum has central cleaning
Multiforme doesn’t
82
how to reduce pulled elbow
supernation and flexion
hyperpronation and extension
