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1. Fellowship Written - SAQ > Paeds > Flashcards

Paeds Flashcards

1
Q

list 6 causes for stridor

A
  • croup
  • laryngomalacia
  • epiglotitis
  • laryngeal FB
  • retropharyngeal abscess
  • bacterial tracheitis
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2
Q

What are the indications for intbation in croup

A

exahustion
T2rf
T1RF
decreased consciouness and cant protect airway
imminent airway obstruction

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3
Q

What are the steps for managing laryngospasm

A
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4
Q

analgesia options and side effects

A
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5
Q

What are the diagnostic criteria for Kawasaki Disease

A

Fever for 5 days + 4 of the following
* bilateral non purulent conjunctival infection
* mucous membrane changes eg strawberry tongue or red or cracked lips
* polymorphous rash
* peripheral changes eg plantar and palmar erythema
* cervical lymphadenopathy - usually unilateral and painful

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6
Q

what are the key investigations and why in ?kawasaki?

A
  • ECHO - ?CA aneurysm, effusions, MR regurg. now and in 8 weeks
  • cultures - ?bacterial infeciton
  • strep serology - ?strep
  • measles PCR - ?measles
  • FBC - ?thrombocytosis - common in week 2 of disease
  • ECG - long PR
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7
Q

Treatment for Kawasaki

A
  • IV Igs 2g/kg over 10 hours
  • aspirin 3-5mg/kg for 8 weeks
  • steroids
  • pandaol, fluid, fibrinolytics
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8
Q

2 year old with abdo pain
findings

Diagnosis

A

soft tissue mass/shadow RUQ
small bowel distension left side
paucity of gas central

bowel obstruction

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9
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
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10
Q

what are the common causitive agents for bronchiolitis?

A
  1. RSV
  2. parainfluenza
  3. human metapneumovirus
  4. rhinovirus
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11
Q

what clinical features warrant admission for bronchiolitis

A

poor feeding
apneoic episodes
markedly tachypnoeic
sats under 90

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12
Q
A
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13
Q

what factors increase risk of apnoea in bronchiolitis

A

low birth weight
premature
under 3 months old
immunodeficient
comorbidities

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14
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

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15
Q

differential diagnosis for bronchiolitis and descriminatory finding

A
  1. bacterial pneumonia - one sided creps, signs of sepsis
  2. cardiac failure - murmur, hepatomegalt
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16
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
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17
Q

characteristic examination finding of bronchiolitis

A

widespread coarse crackles to the midzone

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18
Q

initial management of severe bronchiolitis

A
  • Cancel orders for adrenaline and salbutamol
  • Senior review to confirm diagnosis
  • High flow nasal prongs: 2L/Kg, titrate fiO2 for SpO2 94-98%
  • NGT placement v IV for hydration
  • Admission under paediatrics
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19
Q

what is the criteria for a BRUE (Brief resolved unexplained event)

A
  • 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
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20
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
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21
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

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22
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
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23
Q

sick child rang through - what immediate steps do you make?

A
  1. clear resus bay and ensure department handed over
  2. prepare medical roles
  3. ensure nursing roles
  4. involve paeds/anaesthetics/ICU
  5. get paeds resus trolley
  6. prepare paeds drugs and doses
  7. paeds airway and access stuff
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24
Q
A
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25
Q

what are three non duct dependant causes of neonatal cardiac disease

A

TOF
VSD
ASD
trucus arteriosis

remember
arrthymias
cardiomyopathy

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26
Q

what endocrine issues can cause neonatal collapse

A
  • congenitial adrenal hyperplasia
  • addisons
  • electrolyte disturbance
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27
Q

intepret

treatment

A

right middle lobe pneumonia

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28
Q

abx duration for pneumonia

A

3-5 days

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29
Q

w

what are the possible reasons for recurrent pneumonia in children?

A

recurrent re-infection
bronchiectasis
inhaled FB
CF
immunedeficiency

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30
Q

what further investigations would you do for recurrent chest infections?

A

FBC
Igs
sweat test
CT chest
bronchoscopy

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31
Q

features and most likely diagnosis

A

Features
* discrete lesions of various sizes
* purpura
* ?brusing
* across foot and distal leg

Most likley diagnosis
HSP

Differentions
ITP
TTP
HUS
meningitis
SJS/TEN

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32
Q

Why is this HSP?

Symptoms?

A

HSP rash usually on lower legs and buttocks
characteristic brusing appearance

Sx
joint pain
abdo pain
renal failure
rash
post viral
swelling in hands and feet

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33
Q

what investigations would you do and why for ?HSP

A

urinalysis - ?blood in renal failure
BSL - ?sepsis
FBC - ?sepsis or thromboytopenia
Plt - ?ITP
cultures - ?sepsis

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34
Q

what are the complications of HSP?

A
  • renal failure - nephritis
  • GI haemorrhage
  • intersussception
  • torsion
  • orchitis
  • recurrent HSP
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35
Q

what are the categories of dehydration severity

A
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36
Q
A
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37
Q

what clinical signs should be monitored during rehydration?

A

weight
urine output
CRT
HR
ongoing losses
signs of overload

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38
Q

what congenital syndromes are associated with neonatal bowel obstruction?

A

CF
Downs

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39
Q

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) 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

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40
Q

with neonatal bowel obstruction needing transfer, what should be done to ensure a safe transfer?

A
  1. vital signs documentation
  2. oxygen as required
  3. temp noting and monitored
  4. BSL measurement and correcting if needed
  5. IV access
  6. IV fluid manaement
  7. NG on free drainage
  8. AXR
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41
Q

what are the non congentital causes of neonatal bowel obstruction

A

gastric volvulus
gastric atresia
duodenal web
intersusccpetion
hirscsprungs
meconium ileus
colonic atresia
anal atresia
anorectal abnormalities

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42
Q

what are the criteria for a simple febrile convulsion?

A

none of the following
1. focal features at onset or during
2. more than 15 mins
3. recurrence within same febrile illness
4. incomplete recovery within one hour

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43
Q

febrile convulsion

A
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44
Q

abnormalities and clinical impression

A

spiral fracture of left humerus
NAI

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45
Q

if you suspect NAI what are the important components of an exam

A

exam for signs of neglect and abuse
* burns
* multiple bruises inconsistent with age
* other fractures
* bite marks
* development assessment

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46
Q

fracture with suspected NAI
Management

A
  • analgesia
  • plaster or reduction
  • admit
  • notify child services
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47
Q

what features of an injury history are consistent with NAI

A
  • **inconsistent mechanism
  • inconsistent history**
  • delayed presentation
  • multiple presentations
  • DV
  • FH with other siblings
  • substance abuse
  • foster care
  • single parent family
  • FTT
  • inappropriate interactions
48
Q

other than fractures what injuries are associated with NAI

A

Soft Tissue
○ Any injury in ‘non mobile’ child of this age is a concern
○ Various Bruises
○ Various Ages
○ Circumferential Injuries
○ Usually NOT over bony prominences

● Burns
○ Cigarette burn
○ Immersion pattern on legs
○ Buttocks
○ Genital Areas
○ Hands

● Head Injury
○ Intracranial haemorrhage(s) - various - e.g. EDH
○ Retinal heamorrhage(s)

● Abdominal
○ Perforated viscus, solid organ injury

49
Q

what examination features of a child would indicate a LP?

A
  1. bulging fontanelle
  2. irritable and unconsolable
  3. neck stiffness
  4. petichial non blanching rash
  5. photophobia
  6. no other source
50
Q

what features need to be met for safe discharge of a child with a fever

A
  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
51
Q
A
52
Q

FTT

features of exam and relevance

A
  1. vital signs - look for shock eg sepsism congenital heart disease
  2. weight, length, head circumferance - for growth chart to compare with birth
  3. fontanelle - ?raised ICP
  4. chest exam - ?pulmonary oedema
  5. CVS - murmurs/coarctation
  6. jaundice -?biliary atresia
  7. bruising - NAI
53
Q

FTT
investigations and relevance

A
  • BSL – hypoglycaemia in metabolic conditions, sepsis
  • ECG – tachyarrhythmias can present as failure to thrive
  • VBG – assess degree of hypoperfusion – eg lactate / metabolic acidosis
  • Bilirubin / LFTs – esp if jaundiced – exclude congenital liver problem
  • FBC – anaemia from congenital haemolytic cause
  • Septic screen – urine / CXR / LP where indicated from examination to exclude infection
  • Urine for metabolic screen – where suggested by hx or metabolic acidosis
54
Q

what can neonatal jaundice cause if left untreated?

what are the complications?

A

**kernicterus **- chronic bilirubin encephalopathy

Complications
* Acute - seizures and coma
* chronic - cerebral palsy, developmental delay, death

55
Q

what are the benign and pathological causes of neonatal jaundice?

A

Benign
* breast milk jaundice
* normal physiological jaundice due to immature hepatocytes

Pathological
* Sepsis
* haemolysis (rhesus, ABO)
* liver trouble - hepatitis, biliary atresia
* bowel obstruction
* hypothyroidism

56
Q

how can serum bilirubin help with assessment of neonatal jaundice?

A
  • higher total level the greater the risk
  • conjugated worse as indicates obstructive cause
57
Q
A
58
Q

what are the maternal and neonatal risk factors for significant hyperbilirubinaema?

A

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

59
Q

neonatal jaundice

A
60
Q

what are the indications for bloods on a kit with gastro

A
  • renal disease
  • diuretic use
  • altered conscious state
  • profuse loss
  • ileostony
  • ?sepsis
  • prolonged symptoms
  • hypoglycaemia
61
Q

what clinical signs indicate severe dehydration

A
  • altered conscious state
  • CRT over 4 seconds
  • sunken eyes
  • dry mucous membranes
  • reduced urine output
62
Q

What is an appopriate rehydration regime for moderate dehydraiton

A

anti emetic if vomiting
ORS
IV v NG

slow 10-20mls/kg/hr
rapid 25mls/kg/hr

63
Q
A

HUS
haemolytic anaemia
infection with dehydration
hepatitis/cholecystitis/intersussception

64
Q

a kid - interpret

A

Normocytic, normochromic severe anaemia, associated reticulocytosis. Coombs
negative (non immune mediated)
* Suggestive haemolytic anaemia

65
Q

causes of a generalised seziure in a child

A

hypoglycaemia
hypoxia
febrile illness
head trauma
toxins

66
Q

child seizure

A
67
Q

what is the treatment of a non febrile seizure in child

A
  1. stop seizure - iv midal 0.1ml/kg
  2. give sugar if hypoglycaemic 2ml/kg 10% dexrose
  3. IV phenytoin
  4. prepare for intubation/support airway 20ml/kg
68
Q

define syncope

A

abrupt loss of consciousness and postural tone from transient global hypoperfusion followed by spontaenous complete recovery

69
Q

what is the most common cause of syncope in children

what syncope is unique to preschool

A

vasovagal

breath holding

70
Q

what are the red flag features of paediatric syncope

A
  1. syncope during exercise
  2. chest pain prior
  3. sob prior
  4. palpitations prior
  5. FH sudden cardiac death
  6. known structural heart disease
71
Q

what paediatric syncope, what conditions do you look to rule out on an ECG

A
  1. HOCM
  2. brugada
  3. Long QT
  4. short QT
  5. WPW
  6. AVRD
72
Q

what is the difference between petichae and purpura

A

petichae - small pinpoint lesions less than 2mm
purpura - larger non blanching spots

73
Q

differentials for petichae in kids

A

Thrombocytopenia
Increased destuction - ITP, TTP
* Decreased production*, leukemia, aplastic anaemia, fanconi anaemia

Platelet dysfunction
* congential
* acquired eg NSAIDS

Coagulation deficiencies
* congenital - VWD
* acquired - liver disease, vit k deficiency*

Loss of vascular integrity
* trauma and increases venous pressure eg strangulation, coughing, tournequet
* vasculitis - HSP, SLE
* Toxins - penicillins
* Sepsis - DIC

74
Q

describe acid base disturbance and likely diagnosis

A

Hypochloraemic Metabolic alkalosis – HCO3 51
Respiratory compensation – Expected CO2 is 0.7x51 + 20 = 55
HAGMA – anion gap is 138 – 69+51 = 18

pyloric stenosis - confirm via US

75
Q
A
76
Q
A
  • Infective - pneumonia, meningitis
  • cardiac - duct dependent lesion, non cyanotic congenital heart disease
  • surgical - malrotation, intersussception
  • neuro - seizures
  • trauma - ICH
  • endocrine - CAH
  • metabolic - hypoglycaemia
77
Q

unwell kid
describe and interpret

A

RUL collapse/consolidation
LUL consolidation
NG in not far enough

pneumonia or bronchiolitis with collapse

78
Q

laryngoscope size for kids

A
79
Q

k

key features and diagnosis

A

Features
distressed infant
erythema to face torso and limbs
desquamation to various parts
no mucous membrane involvement

Stap scolded skin syndrome

80
Q
A
  • 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
81
Q

what exam featurs suggest inhaled FB

A

focal monophonic wheeze
focal consolidation
unilateral hyperinflation

82
Q

what are the drug doses for paeds RSI

A
  • Suxamethonium – 1-2mg/kg
  • Ketamine – 1-2 mg /kg
  • Fentanyl – 2-3 mcg/kg
83
Q

what equipment do you want ready for paeds RSI

A
  • Bag/valve mask/neopuff/anaesthetic circuit
  • ETT size 3.5 cuffed (Accept 3 and 4)
  • Paedcap/capnography
  • Laryngoscope size 1 &2 miller and/or mc blade
  • Ventilator
  • Suction catheter
  • Oropharyngeal/nasopharyngeal airways
  • Stylet/bougie
  • LMA (Size 1)
84
Q

describe abnormalities
differentials

A
  • Severe hyperkalaemia
  • Hypoglycaemia
  • Partially compensated metabolic acidosis
  • Mild hyponatraemia

Differentials
CAH
dehydration
renal failure
sepsis
heart failure
inborn error of metabolism

85
Q

what are the tests for CAH?

A

serum cortisol and 17 hydroxyprogesterone

plasma renin and ACTH

86
Q

what is the treatment for a baby with CAH?

A
  • 10% dextrose 2-5mls/kg
  • IV fluids – 10 mls per kilo normal saline
  • FIRST LINE Steroids – stress hydrocortisone 25mg initially then 5-10 mg 6 hourly

Extra
Mineralocoricoid replacement - Fludrocortisone 0.05-0.1 mg
daily

87
Q

desribe rash and diagnosis

causes

treatment

A

erythematous, raised plaques, confluent, target sign =** Erythema multiforme**

Causes
Infection - HSV 1 and 2, mycoplasma, VZV, adenovirus

*Drugs *- NSAIDS, penicillins

no specific treatment

88
Q

sore throat and rash
describe rash
diagnosis

A

erythematous, widespread, macular

Scarlet fever
dd:
measles
rubella
drug eruption

89
Q

what is the treatment for scarlet fever

A

penicillin

90
Q

what are the complications of scarlet fever

A
  • Renal failure
  • Rheumatic heart disease
  • Abscess – peritonsillar or retropharyngeal
  • Bacteraemia/ Sepsis
  • Pneumonia
  • Hepatitis
91
Q

what causes a blistering rash in children

A
  • staph scolded skin syndrome
  • SJS/TEN
  • bullous impetigo
92
Q

relevant findings and diagnosis

A

HAGMA: AG= Na – (HCO3 + Cl)
Appropriate respiratory compensation
CO2 = 1.5*HCO3 + 8

Diabetic ketoacidosis

93
Q

why do you get the following in DKA
* low Na
* Low Cl
* high K

A
  • low Na - dilutional due to hyperglycaemia
  • Low Cl - loss from kidneys to maintain electrucal neutrality due to ketones
  • high K - due to acidosis
94
Q

what investigations may you do in a child with first time DKA

A

Serum ketone finger prick – in DKA to monitor response to treatment with serial measures

UEC – assess for pre-renal renal failure with DKA
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

Serum antibodies – in first time DKA
(Accept other thigns that look for cause if explained well – BC, LP)

95
Q

Treatment for DKA

A
  • Bolus 10ml/kg N/S aiming for improved perfusion
  • Replace fluid deficit over 24 -48 hrs (deficit plus maintenance)
  • -Initially use N/S then change to N/S plus 5%D when BSL <15
  • Add 20-40mmol/L K to each bag once K <5.5
  • Insulin 0.1U/kg infusion
  • Correct cause eg Abs for sepsis
96
Q

what are the obstructive and non obstructive causes of neonatal vomiting

A

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)

97
Q

causes of paediatric anaemia and findings on film/FBC

A
  • 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 – schistocytes, red cell fragments
  • Abnormal red cells – ie spherocytosis - spherocytes
98
Q

differentials

A

measles
chicken pox
rubella
slapped cheek (parvo)
viral xantham
CTD
SJS/TEN
staph scalded

99
Q

what are the measles specific features of history and exam

A

History
Rash day 3-5 of fever
starts on face
unimmunised/contact history

Exam
Kopliks spots
conjunctival injection
coryza

100
Q

management of measles

A

● 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

101
Q

what is the test for measles

A

IgM/IgG serology
Nasal PCR

102
Q

what are the complications of measles

A
  • pneumonitis
  • meningitis
  • encephalitis
  • otitis media
  • acute sclerosing panencephalitis
  • dehydration
103
Q

what are the risk factors for post natal depression

A

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

104
Q

what are the indicators for admission to hospital with post natal depression

A

psychosis
thoughts of self harm
thoughts of infant harm
any suicidality
poor social support

105
Q

what are the risk factors for neonatal resus

A
106
Q

how can you estimate gestiational age?

A
  • enquire about LMP
  • fundal height umbi at 20 weeks xiphsternum at 36
  • Ultrasound measures eg femur length
107
Q

clinical signs of a duct dependant lesion

Treatment

A

cyanosis/hypoxia
no femoral pulses
hepatomegaly
murmur

Treatment
prostaglanding infusion NB apnoea
100ng/kg/min

108
Q

what are the cardinal features of life threatening asthma?

A
  1. confusion
  2. coma
  3. exhaustion
  4. hypotension
  5. poor respiratory effort
  6. silent chest
  7. cyanosis
109
Q

what is the immediate management of severe asthma in a child

A
  1. salbutamol 6 puffs inh/neb 20 minutely for one hour then review
  2. ipatropium bromide 4 puffs 20 minutely
  3. pred 1mg/kg
  4. magnesium sulphate 50mg/kg IV bolus
110
Q

what are the complications of severe asthma post treatment?

A
  • worsening hypoxia of hypercarbia despite treatment
  • apnoea
  • altered consciounsess
  • pneumothorax
  • vomiting
  • agitation secondary to salbutamol
111
Q

ventilation settings in asthma

A
112
Q

causes of hypotension and tachycardia post intubation

A

incorrect tube position
equipment failure
tension pneumothorax
gas trapping
affect of agents

113
Q

dose and side effects of second line asthma treatment

A
114
Q

what are the potential complications of intubating a child with asthma

A

tension pneumothorax
barotrauma
hypotension
cardiac arrest

115
Q

asthma intubation

A

Hypoxia/ Pre-oxygenation: HFNC 15lpm throughout, consider BiPAP as pre-ox strategy, avoid apnoea, induce sitting up

High-pressure ventilation: manual ventilation, increased pressure limits to maintain
PPlat <30cmH20

Cardiovascular collapse with raised thoracic pressures: Fluid bolus, start adrenaline

Dynamic Hyperinflation: Slow bag – 4-6/min, disconnect from ventilator

116
Q
A

Positive
* mass in hilar, lilely mediastinal
* intubated with ET tube correctly cited
* left lung hypoinflation

Negative
* no mass
* no cardiomegaly
* no pleural effusion
* no bony involvement

Differentials
Lymphoma
TB
thymic cyst
goitre
thymoma
neuroblastoma

1. Fellowship Written - SAQ (25 decks)

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