Paeds Flashcards
Where do the retractions occur that signify respiratory distress
- substernal
- suprasternal
- subcostal
- intercostal
absent/weak femoral pylses can indicate?
coarctation of the aorta
types of cleft lip
can be incomplete (small gap in the lip) or complate (continue to the nose)
problems that occur with cleft lip
feeding -> need special bottles
airway problems
associated anomalies
- hearing screen
- cardiac echo
- check for trosomies
concerning features about spinal dimples
if large/off the midline , high or with cutaneous marker (hairy tuft)
-> spinal imaging
where does the haemorrage occur in cephalohaematomas
occurs between the periosteum and the skull bone.
This is due to the rupture of blood vessels within the periosteum, typically caused by birth trauma. Since the periosteum is tightly bound to the bone and does not cross suture lines, cephalohematomas are limited by skull sutures and do not extend beyond them.
how will cephalohaematomas present
localised soft translucent swelling over one or both sides of the head
becomes maxiaml in size by 3-4th day of life
occaisonaly if large -> haemolysis can result in increased or prolonged neonatal jaundice
no association wit intracranial bleeding**
what is talipes
medial (varus) or later (valgus) deviation of the foot
often positional and requires - physiotheraphy
if fixed -> strapping, casting or surgery
CHECK for development dysplasia of the hip!!
tests for development dysplasia of the hip
barlow test
ortolani test
Developmental dysplasia of the hip treatmtnet
pavlik harness
surgical reduction
Features of Trisomy 21
dysmorphism
- low set ears
-upward slanting palpebral fissures
- epicantic folds
- single palmer creases
- wise sandal gap
babies can be hypothermic in sepsis
a. true
b. false
a. true
struggle to mount response with temperature
risk factors for sespsis in children
PROM
maternal pyrexia
maternal GBS carriage
management of sepsis in babies (tests)
septic screen (FBC, CRP, cultures, blood gas)
CXR, LP
treatment of sespis in preterm
* IV penicillin and gentamicin 1st line
* 2nd line vancomycin
add metronidazole if surgical /abominal concerns
- Treat newborn babies under 28 days who are more than 40 weeks corrected gestational age who present with community acquired sepsis with ceftriaxone 50 mg/kg
fluid management and treat acidosis
common causes of neonatal sepsis
GBS* 1st
E.coli
Listeria
Coag-neg streptococci
haemophilus influenza
when does GBS sepsis most likely to occur
early onset
from birth until 1 week
late onset (up to 3 months)
non-sepcific symptoms and can have no RF
common congenital infections
toxoplasmosis
rubella
cytomegalovirus (CMV)
HSV
when does transient tachyapnoea of the newborn occur, symptoms and what is the cause
within the first few hours of life
(grunting, tachypnoea, oxygen requirement, normal gases)
due to delay in the clearance of foetal lung fluids
treatment of transient tachyapnoea of the newborn
supportive,
antibiotics, fluids, o2 , airway support
symptoms of meconium aspiration
cyanosis
increased work of breathing
grunting, apnoea, floppiness
what is the risk factors for meconium aspiration
post - date
maternal diabetes
maternal hypertension
difficult labour
important blood tests for meconium aspiration
blood gas
septic screen
CXR
septic and respiratory causes of hypoxia are most common in babies than cardiac
a. true
b. false
a. true
what are the 5 causes of congenital cyanotic cardiac disease
- Truncus ateriosus
- TGA
- Tricuspid atresia
- ToF
- TAPVD
How is hypoglycaemia managed in newborn babies
if in NNU - may still manage with enteral feeds
- start IV 10% glucose
increase fluids
increase glucose concetration (Central IV access)
glucagon
hydrocortisone
how is hypothermia managed
if unable to maintain temperature
-> place in incubator
sepsis screen and antibiotics
consider checking TFT
monitor blood glucose
What are the 2 stages of asphyxia where damage can occur to baby
1st - within minutes - cell damage occurs with lack of 02 and blood flow
2nd - reperfusion injury (Can last for days or weeks) - toxins are released from damaged cells
how is hypoxic ischaemic encephalopathy managed
HIE can be mild, moderate or severe.
supportive
fluid restriction (Avoid cerebral oedema)
treat seizures
therapeutic hypothermia (Cooling - improves the outcome in moderate group_
what side of the body is a diaphragmatic hernia most likely to occur
90% on the left side
males >
what is a diaphragmatic hernia
birth defect - opening in the diaphragm allows abdominal organs (stomach , intestines and liver to move into the chest cavity)
increases the pressure on lungs - respiratory distress/cyanosis /abdominal distrension or swollen as contents pushed into chest
what is neonatal abstinence syndrome (NAS)
withdrawel from physically addictive substances - taken by the mother in pregnancy
(opiods, methadone, heroin, beznos, cocaine etc)
-> treatment (comfort - swaddling, morphine, phenobarbitone)
treatment for neonatal abstinace syndrome
comfort- swaddling
morphine
phenobarbitone
monitor/diagnosis - finnegan scores/ urine toxicity
when to start antibiotics in suspected sepsis
start within 1 hour
a limp can be due to growing pains
a. true
b. false
b. false
never ascribe a limp to growing pains
what is Juvenile Idiopathic Arthritis (JIA) and some symptoms
a group of autoimmune and inflammatory conditions affecting children under 16 years of age. It causes persistent joint inflammation, pain, and stiffness.
morning stiffness and getting stiff after rest
joint pain
swelling in joints
warmth and reddness
uveitis - redness pain and blurred vision
what tests would you consider for JIA
Blood tests (to check for inflammation and markers like RF, ANA, ESR, CRP)
Imaging (X-rays, ultrasound, MRI) to detect joint damage
Eye exams (to check for uveitis)
Exclusion of other conditions (such as infections or other autoimmune diseases)
what test would you order if you noticed motor development was delayed
CK test
examination to assess all joints quickly
pGALS
(Pediatric Gait, Arms, Legs, Spine) Test
The pGALS test is a quick and simple musculoskeletal screening tool used to assess joint problems in children. It helps detect juvenile idiopathic arthritis (JIA) and other musculoskeletal conditions.
when to refer to ortho for a limp
persisting beyond two weeks
when do send to ortho on same day referal
febrile child wiith limp
non weight bearing
red flags - fever, weight loss, night pain, lethargy, new cardiac murmur
symptoms of septic arhtritis
- acute onset of FEVER
- joint pain and swelling
- unwell
*irritable
*tachycardia
*joint effusion
*warmth and tenderness
*PAIN ON MOVEMENT
lab results in septic arthritis
- elevated ERP and CRP
- raised WBC and platelets
- Blood cultures - can be negative
*USS - effusions
treatment of septic arthritis
joint aspiration
IV antibiotics
refer to ortho
what is slipped upper femoral epiphysis (SUFE)
displacement of the femoral epiphysis from the femoral neck
adolescenes - most common
key associated factors around SUFE - slipped upper femoral epiphysis
adolescent child
obease
pain and altered gait
worse on activity
XR of SUFE would show
ice creaming slidding off cone - head of femur sliding off epipihysis downwards
refer to ortho
Transient Synovitis in Children
describes?
a temporary inflammation of the hip joint in children. It is the most common cause of hip pain in children, typically affecting those between 3 to 10 years old. It usually occurs after a viral infection, like a cold or sore throat, but the exact cause is often unclear.
symptoms of transient synovitis
- Hip pain (may also be felt in the thigh, groin, or knee).
- Limping or difficulty walking, especially after activity.
- Stiffness or limited range of motion in the hip.
- Mild fever (but not always).
- Pain may be worse after activity or in the morning.
symptoms < 1 week
are NOT UNWELL looking
US - will should bilateral effusion
what is perthes disease
idopathic AVN of the hip
-
how does perthes disease present
insidious hip pain and limp
pain is NOT relieved by rest or medication
peak 5-7
management of perthes
minimal weight bearing
paediatric othropedics
contain the head within the acetabulum with use of splints
osteotomy (surgery - ocasionally)
symptoms of JIA
arthritis lasting at LEAST 6 weeks
morning stiffness or gelling
refusal to walk as toddlers
school absence/limitied participation in physical activity
rash/fever
fatigue
poor appetite / weight loss
delayed puberty
signs yuo would see in JIA
arthritis lasting 6 weeks +
swelling, swollen tendons (tenosynovitis)
tenderness
joint held in position of maximum comfort
ROM is limited at the extremties
what might you see if JIA was systemic in children
- unwell!!
- intermittant fevers > 2 weeks
- salmon pink erthematous rash
- generalised lymphadenopathy
- serositis
- hepatomegaly/splenomegaly
RAISED inflammatory markers
treatment for JIA
NSAIDs, DMARDs, biologics
intrarticular and oral steriods
nutrition
physiotheraphy
treatment for JIA
- intra-articular steroids
- methotrexate DMARD
- Biologics - anti-TNF/newer biologics
treatment for JIA
- intra-articular steroids
- methotrexate DMARD
- Biologics - anti-TNF/newer biologics
invesitgations for JIA
labs
XR
US
MRI with contrast
what can induce remission in JIA
intra-articular steroids !!! - esp only 1 joint is affected!!!
safe and effective
remission in > 6 months
DMARD used in JIA
methotrexate -
if poor response to IAS in olgi JIA
mostly given as injection
JIA is associated with which eye problem
uveitis
- can become chronic if untreated
all children with JIA will undergo screening
more common if ANA positive
< 5 years old
how does uveitis present in JIA
red eyes
headache
reduced vision
cataracts , glaucoma, blindness
investigation for uveitus
slit lamp
all children within 6 weeks who have JIA
treatment of uveitis in JIA children
topical sterioids to reduce inflammation 1st
more severe -> systemic steroids
- if poor response -> DMARD and biologics
complications of JIA
poor growth
osteopenia
localised growth disturbances
micrognathia *abdnormally small mandable
contractures
ocular vision problems
unlicensed medicines mean?
no license for human use in this country
what does off label mean
not license for use in children below age of 16/18 or via a certain route
why are neonates and infants more sensitive to drugs
organ system immaturity
greater individual variation
pre term
< 37 weeks
neonate
0 days old to 27 days of age
child age
2 years - 11
adolescent
`12 - 16/18
which antidepressant is highly toxic in paediatrics
paroxetine - SSRI
increased risk of suicide
why is the oral route of medication different in children
reduced gastric acid and delayed gastric emptying (until 3 years old)
- absorption in the GI reaches adult values by 6-8 months
drugs that are absorbed in stomach/go past liver
highly variable /reduced effectiveness
drugs absorbed via the skin are enhanced
a,true
b. false
a. true
-> espeacially wtih daamge skin or occlusive dressing
-> STEROIDS
how does GI system affect medication in children
reduced absorption due to
- reduced gastric acid
- slow gastric emptying
- reduced GI motility
reduced in liver
- less pancreatic enzyme activity
skin permeability is greater in children
a, true
b, false
a,. true
how is elimination of drugs affected
reduced renal blood flow
reduced GFR
tubular function reduced
all decreasdd in children - less clearance
immature livers are less ablet o metabolise drugs
a. true
b. false
a. true
drugs to reduce the risk of tumour lysis syndrome after chemotheraphy
allopurinol (lowers serum urate)
or
rasburicase
give prior to chemo
definitive diagnosis for sickle cell disease
haemoglobin electrophoresis
coeliac disease can cause hyposplenism
a,true
b. false
a, true
-> target cells and howell jolly bodies can be seen in coeliac disease on blood film
codeine is not recommended in kids under 12
a.true
b. false
a. true
how are maintenance fluids calculated in children
4ml/kg for 1st 10kg
2ml/kg 2nd 10kg
1ml/kg - every kg thereafter
0.9%NaCl + 5% dextrose
fluid resus in children = what used?
20ml/kg bolus 0.9% sodium chloride
how are maintenance fluids calculated in children
4ml/kg for 1st 10kg
2ml/kg 2nd 10kg
1ml/kg - every kg thereafter
0.9%NaCl + 5% dextrose
murphys triad for appendicitis
- pain
- vomiting
- fever
and tenderness over mcburneys point
symptoms of mesentric adenitis
hight temp
frequent UTRI
not unwell
generalised abdo pain
best
treatment for malrotation and volvulus
asap lapartomy
investigation for intusseception
USS - abdomen
- target sign
management of intussusception
air enema - pneuomstatic reduction
laparotomy
umbilical hernia presentation
umbilical swelling
present from 4 days old
worse when crying
easily reducible
treatment of umbilical hernia
usually closes by 4 years on its own
rare if complications - repair or if > 4 years and large
where do paraumbilical hernias occur
A paraumbilical hernia occurs just next to the belly button, off-center but still near the umbilicus.
usually acquired and occurs later in childhood or adulthood. It develops due to weakness in the abdominal wall, often from increased pressure, such as from obesity, straining, or chronic coughing.
Gastroschisis is a birth defect in which a baby is born with
internal organs (such as the intestines) located outside the body through a hole in the abdominal wall. The hole is typically located to the right of the umbilicus (belly button), and the organs are not covered by a protective sac or membrane, unlike in a similar condition called omphalocele.
Exomphalos, also known as omphalocele, is a birth defect in which
baby is born with internal organs (such as the intestines, liver, or stomach) protruding outside the body through an opening in the abdominal wall. Unlike gastroschisis, the organs in exomphalos are contained within a sac made of amniotic membrane and peritoneum (the lining of the abdomen), rather than being exposed directly to the air.
associated with trisomy - 12, 18, ,21
other anomaltieis - cardiac, etc
beckwtihweideman syndrome
differences in airway anatomy in children
large head to body size
short necks
large tongue
nasal breathers - obligate
nasal passage easily obstructed
compressible floor of mouth and trachea
high anterior larynx
children have fewer type1 (slow twitch fibres)
a. true
b. false
a. true
easily fatigable when breathing
how do childrens airways differ
smaller total surface area for air tissue interface
lower airways are small and easily obstructed
diaphragmatic breathing (use diaphragm rather than chest)
soft- non calcified bones are very compliant (chest wall recession and indrawing)
horziontal ribs -=> less expansion
why is there indrawing and recession when children have difficulty breathing
soft and non-calcified bones - are very compliant
children have fever type 1 slow twitch fibrers
a. true
b.false
a. true
children have more horziontally shaped ribs
a. true
b. false
a. true
allows LESS chest expansion
___ ____
_____ _____
why is the RR higher
have a higher metabolic rate
HbF drives the dissociation curve what direction?
LEFT
will be more left in neonates (hBF predominates) and will tolerate lower saturations
circulatng blood volume in babies
is small
70-80ml/kg
small loss can make a huge difference
systemic vascular resistance progressively rises after birth
a. true
b. false
a..true
(blood pressure gradully rises)
-> falling BP in children is a late sign
bradycardia indicates life threathening pathology in children
a. true
b.false
a. true
can be seen in anorexia
why do children loose heat
large surface area to weight ratio
RR if under 1
30-40
anaphylaxis is what type of hypersensitvity reponse
type 1
HR if under 1
110-160
what is a choleochal cyst
A choledochal cyst is a congenital condition in which a cystic growth or dilation occurs in the bile ducts — the tubes that carry bile from the liver and gallbladder to the small intestine.
This condition can cause blockages in the bile flow, leading to various complications, including infection, liver damage, or even pancreatitis.
treatment of DKA
IV access
**+/- fluid resus *0.9% Saline bolus (No K+)
IV insulin - no bolus (1 hour after fluids)**
(IV fluids maintaince + correction with K+ later)
treatment of DKA
IV access
**+/- fluid resus *0.9% Saline bolus (No K+)
IV insulin - no bolus (1 hour after fluids)**
(IV fluids maintaince + correction with K+ later)
treatment of meningitis with septicaeimia
Sepsis 6
20ml/kg 0.9 saline
IV cefotaxime or ceftriaxone
LP/CXR when stable
