Paeds Flashcards
Croup and gender?
More common in boys than girls
A 5-year-old child presents to the emergency department accompanied by the mother with a week history of cough and low-grade fever. The mother describes the cough as barking. She has completed all the vaccinations to date.
On examination, you can observe suprasternal wall retraction at rest, but the child looks alert and reactive. The child produces strident breath sounds at rest.
What is the most appropriate management plan?
Admission
- due to the strident sounds AT REST
THIS IS CROUP
Admission for bronchiolitis
Indication : grunting
palivizumab
What best describes this medication and its indication?
Palivizumab is a monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.
for bronchiolitis
You are reviewing a 6-month-old child with suspected bronchiolitis. Which one of the following should prompt the consideration of a hospital referral?
Grunting
feeding 50% of normal
RR of 60 +
urine culture is reported as positive for growth of proteus species >10⁵ cfu/mL sensitive to cephalexin, trimethoprim and nitrofurantoin. Is this result significant?
A pure growth greater than 10⁵ is significant. Isolation of proteus from the urine often indicates underlying renal tract abnormalities and predisposes to renal calculi. These calculi are usually radio-opaque
A – renal cortex
B – renal sinus fat-bright
C – dilated renal pelvis
D – dilated upper ureter
E – dilated calyces
Vesico ureteric reflux which is severe and reaching the kidney can cause ?
pelvicalyceal system dilatation
what can you do to exclude epididymo orchitis when considering torsion
Urine microscopy:
linked to STI + UTI history
Molluscum contagiosum is what type of organism
Virus:
Papules
Central dimpling
If a child admitted to hospital with a rash turns out to have measles, what notfiying and precautions must be taken
Ensure the patient is being managed in a side-room with respiratory precautions
Inform the hospital infection control team
Inform the local Health Protection Consultant by phone even if out of hours
DMSA is looking for structural changes so scarring
The answer is klebsiella in <6 months
as this is atypical organism (ecoli is very common) in a small child
An eight-year-old female presents to the General Practitioner surgery with her mother for an asthma review. She is taking Clenil® Modulite® (beclometasone) 100 μg twice daily as a preventer inhaler but still needs to use her salbutamol inhaler at least 2–3 times per day. On examination, she can complete sentences, is not using any accessory muscles of respiration, her oxygen saturation is 99%, her chest is clear, and PEFR (peak expiratory flow rate) is 85% of her predicted.
What should be the next step in this patient’s management plan according to the latest BTS guidelines?
the next step for children aged 5-12 with poorly controlled asthma symptoms despite low-dose ICS would be to consider adding a LABA, like formoterol, in combination with ICS, rather than using a LABA alone. This step aligns with the recommendation to use a combination of ICS and LABA.
An 8-year-old boy presents to the emergency department severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.
Which of the above is most concerning?
The normal CO2!
normal pCO2 in an acute asthma attack indicates it is life-threatening
If asthma control test is 25/25 ? how do you step down with asthma treatment
In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids
A 7-year-old boy is brought to the GP by his mother with worsening asthma symptoms. He was diagnosed with asthma 6 months ago and has been using a beclometasone 100 mcg inhaler (2 puffs twice daily) and salbutamol as needed. His mother reports that he has been using his salbutamol inhaler 3-4 times per week, has been waking at night with cough once or twice weekly. His peak flow readings have been consistently around 80% of his predicted value.
What is the most appropriate next step in management?
assess if eligible for MART regime in child ages 5-11 with asthma not controlled with ICS+SABA
(Maintenance and Reliever Therapy (MART) regime. MART involves using an ICS/formoterol combination inhaler for both daily maintenance therapy and symptom relief as needed.)
A 6-year-old boy is taken to the emergency department by his mother with several days of wheezing. He also describes some chest tightness and is coughing up clear phlegm. He has a past medical history of asthma and uses a salbutamol inhaler when needed. Over the past few days, he has been using the inhaler several times daily.
On examination, a widespread wheeze is noted on auscultation of the chest. Observations are within normal limits for his age. His peak expiratory flow rate (PEFR) is calculated as 70% of his historic best value. He can speak in full sentences.
What is the most appropriate next step?
This is a moderate asthma attack
- give oral prednisolone, doesnt need anything else atm
A three-year-old male is brought to the Emergency Department with a six-day history of fever, irritability, red eyes, and reduced eating for the last 24 hours. On examination, he was noted to have dry and cracked lips, mild conjunctivitis and cervical lymphadenopathy.
Given the likely diagnosis, what is the most important investigation?
Serial echocardiogram
An 8-year-old girl presents with one day of vomiting and abdominal pain, and a two-week history of increased thirst, frequent urination, and recent weight loss. She is otherwise healthy, and her sister has a thyroid condition.
The girl is alert with a soft, nontender abdomen. Urine dip shows glucose +++ and ketones ++. Random blood sugar is 33.2. She is diagnosed with diabetes and admitted for an insulin infusion, later discharged with an insulin pen. Over the next two weeks, her blood glucose is well controlled with one unit of insulin daily.
What reason best explains this patient’s current insulin requirements?
x is the single most important blood test to assess a patient’s response to treatment with levothyroxine for Hashimoto’s thyroiditis
Thyroid-stimulating hormone (TSH)
A 2 month old male baby presents with bilious vomiting of 1 days duration. On examination, his abdomen is significantly distended and he is noted to be febrile. Rectal examination induces the explosive release of copious amounts of liquid faecal matter. His past medical history is significant for a diagnosis of Trisomy 21.
An abdominal x-ray reveals distended loops of proximal large bowel.
What is the most likely diagnosis?
Hirshsprungs
Two of the most common causes of failing to pass meconium?
are cystic fibrosis or Hirschsprung’s disease.
Life threatening asthma oxygen sats?
Anything below 92 is indicative of LIFE THREATENING asthma
