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YEAR 5: Specialties > Paeds 5 > Flashcards

Paeds 5 Flashcards

1
Q

How is chondromalacia patellae managed?

A

Physiotherapy for quadriceps strengthening

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2
Q

How is osteochondritis dissecans managed?

A

Pain relief
Rest and quadriceps exercise
Occasionally need surgery

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3
Q

How is subluxation of the patella treated?

A

Reduction and immobilisation

Rehab

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4
Q

Outline the treatment of Perthes disease.

A

o Acute Pain - supporting care with simple analgesia

o < 5 years
• Mobilisation and monitoring (healing potential is good at this age)
• Non-surgical containment using splints

o 5-7 years
• Mobilisation and monitoring
• Surgical containment

o 7-12 years
• Surgical containment
• Salvage procedure (remodel the acetabulum)

o 12+ years
• Salvage procedure
• Replacement arthroplasty

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5
Q

How is septic arthritis treated?

A

Antibiotics (initially IV for 2 weeks, followed by 4 weeks oral)

Suspected Gram-positive
Vancomycin + joint aspiration
2nd line = clindamycin or cephalosporin + joint aspiration

Suspected Gram-negative
3rd generation cephalosporin (e.g. ceftriaxone) + joint aspiration
2nd line = IV ciprofloxacin + joint aspiration

Affected joints should be aspirated to dryness as often as required (through closed needle aspiration or arthroscopically)

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6
Q

What are the aspects of managing juvenile idiopathic arthritis?

A 
Multidisciplinary team
Physiotherapist and occupational therapist 
NSAIDs
Corticosteroids 
DMARDs (methotrexate is first-line)
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7
Q

How is vitamin D deficiency/Rickets treated?

A

Calcium and ergocalciferol OR cholecalciferol

NOTE: pseudovitamin D deficiency is treated with alfacalcidol or calcitriol

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8
Q

How might you investigate a patient presenting with migraines?

A

Headache diary for 8 weeks to help identify triggers

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9
Q

Outline the steps in the acute management of a migraine.

A

Step 1: simple analgesia
Step 2: nasal sumatriptan
Step 3: nasal sumatriptan and NSAID/paracetamol
Step 4: consider adding prochlorperazine or metoclopramide

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10
Q

Which medications are used to prevent migrianes?

A

Topiramate and propranolol

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11
Q

How should you manage a febrile convulsion during the seizure?

A

Protect them from injury

Do not restrain

When the seizure stops, check the airway and place in the recovery position

If > 5 mins –> rectal diazepam (can be done twice) or buccal midazolam (only one dose)

An ambulance should be called if the seizure continues

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12
Q

What should be tested in all children who have a seizure?

A

Blood glucose

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13
Q

Which children who have had a febrile convulsion require hospital assessment by a paediatrician?

A

First febrile convulsion
Diagnostic uncertainty about the cause of the seizure
Focal features of the seizure
Seizure recurs within the same febrile illness (or within 24 hours)
< 18 months old
Parents are anxious
No apparent focus of infection

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14
Q

What is the recurrence rate of febrile convulsions?

A

1 in 3

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15
Q

What are some cardinal features of childhood rolandic epilepsy?

A

Unilateral facial sensorimotor symptoms
Oropharyngeal ictal manifestations
Arrest of speech
Hypersalivation

NOTE: this is not usually treated and children will grow out of it (around 14-18 years)

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16
Q

What is the first-line AED for generalised seizures?

A

Valproate

NOTE: ethosuximide can be used for absence seizures

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17
Q

Name some antiepileptics that can worsen certain forms of epilepsy.

A

Lamotrigine - worsens myoclonic

Carbamazapine - worsens absence

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18
Q

What is the first-line AED for focal seizures?

A

Carbamazepine or lamotrigine

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19
Q

What advice should you give to parents with regards to activities that may be dangerous with epilepsy?

A

Avoid situations where having a seizure could lead to injury or death (e.g. swimming unsupervised)
Driving is allows only after 1 year free of seizures
The school should be made aware of the diagnosis

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20
Q

How is Guillain-Barre syndrome managed?

A

Supportive
Respiratory support
IVIG
Plasma exchange

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21
Q

Which milestones would you expect the average child to have reached by 7 months?

A

Gross Motor: sits without support
Fine Motor: transfers objects from hand to hand
Hearing, Speech and Language: turns to voice, polysylabic babble
Social/Emotional: finger feeds, fears strangers

22
Q

Which milestones would you expect the average child to have reached by 1 year?

A

Gross Motor: stand independently
Fine Motor: pincer grip (10 months), points
Hearing, Speech and Language: 1-2 words, understands name
Social/Emotional: drinks from cup, waves

23
Q

Which milestones would you expect the average child to have reached by 15-18 months?

A

Gross Motor: walks independently
Fine Motor: immature grip of pencil, random scribble
Hearing, Speech and Language: 6-10 words, points to 4 body parts
Social/Emotional: feeds self with spoon, beginning to help with dressing

24
Q

Which milestones would you expect the average child to have reached by 2.5 years?

A

Gross Motor: runs and jumps
Fine Motor: draws
Hearing, Speech and Language: 3-4 word sentences, understands 2 commands
Social/Emotional: parallel play

25
Q

List the median ages for gross motor development milestones.

A

6-8 weeks: raises head to 45 degrees when prone
6-8 months: sits without support (first with round back, then straight back)
8-9 months: crawling
10 months: cruising
12 months: walks unsteadily
15 months: walks steadily

26
Q

List the median ages for vision and fine motor milestones.

A

6 weeks: follows moving object or face by turning head
4 months: reaches out for toys
4-6 months: palmar grasp
7 months: transfers toys from one hand to another
10 months: mature pincer grip
16-18 months: makes marks with a crayon, tower of 3
3 years: draws a circle

27
Q

List the median ages for hearing, speech and language development.

A

3-4 months: vocalises alone or when spoken to, coos and laughs
7 months: turns to soft sound out of sight
10 months: sounds used discriminately to parents (mama/dada)
12 months: 2-3 words other than mama or dada
18 months: 6-10 words, shows two parts of the body
20-24 months: use 2 or more words to make simple phrases
2.5-3 years: talks constantly in 3-4 word sentences

28
Q

List the median ages for social, emotional and behavioural development.

A 
6 weeks: smiles responsively
6-8 months: puts food in mouth 
10-12 months: waves bye bye, plays peek-a-boo 
12 months: drinks from cup
18 months: uses spoon 
18-24 months: symbolic play 
2 years: dry by day 
2.5-3 years: parallel play, takes turns
29
Q

How is paracetamol overdose managed?

A

Measure plasma paracetamol concentration at 4 hours and plot on normogram
Treat with IV N-acetylcysteine if necessary

30
Q

How is carbon monoxide poisoning treated?

A

Presents with headache, nausea, confusion and drowsiness
High-flow oxygen
Hyperbaric oxygen therapy may be considered

31
Q

How is salicylate poisoning treated?

A

Presentation: vomiting, tinnitus, respiratory alkalosis
Measure plasma salicylate concentration at 2-4 hours
Alkalinisation of urine with sodium bicarbonate increases urinary excretion
Consider haemodialysis

32
Q

How is TCA overdose treated?

A

Treat arrhythmias and give sodium bicarbonate

Support ventilation

33
Q

How is ethylene glycol poisoning treated?

A

Presentation: intoxication, tachycardia, metabolic acidosis

Fomepizole inhibits the production of toxic metabolites (ethanol can also be used)

34
Q

How is iron overdose treated?

A

Presentation: vomiting, diarrhoea, haematemesis, late drowsiness/coma/shock/hypoglycaemia

Serum iron level 4 hours after ingestion is the best measure of severity

IV desferoxamine chelates iron

35
Q

How is organophosphorus pesticide poisoning treated?

A 
Supportive 
Atropine (large dose)
Pralidoxime (reactivates actylcholinesterase)

NOTE: presentation is mainly cholinergic features

36
Q

What is a port wine stain?

A

Capillary malformation in the dermis that is present from birth and persists for life
If in the trigeminal nerve distribution, some children may have Sturge-Weber syndrome and should have an MRI

37
Q

Describe the appearance and progression of cavernous haemangiomas.

A

Appears within the first month of life

Grows before shrinking and disappearing (before 5 years)

38
Q

Describe the inheritance pattern of von Willebrand disease.

A

Type 1 and 2 = autosomal dominant

Type 3 = autosomal recessive

39
Q

How should bladder outflow obstruction be investigatd?

A

MCUG

40
Q

What are the two different types of polycystic kidney disease and how do they differ?

A

Autosomal Dominant - mainly in older children/adults, cysts are large

Autosomal Recessive - presents in childhood with bilateral renal masses, respiratory distress due to pulmonary hypoplasia and congenital hepatic fibrosis with pulmonary hypertension

41
Q

What are the aspects of managing Duchenne muscular dystrophy?

A 
Physiotherapy to prevent contractions 
Exercise and psychological support 
Surgery (e.g. tendoachilles lengthening) 
CPAP for nocturnal hypoxia
Glucocorticoids may slow degeneration
42
Q

What’s the main difference between Duchenne and Becker muscular dystrophy?

A

Duchenne - no dystrophin - severe symptoms (LE: 20-30 years)

Becker - abnormal dystrophin - milder symptoms

43
Q

What are some consequences of neural tube defects?

A

Paralysis and muscle imbalance (needs physiotherapy)
Sensory loss (can lead to accidental damage)
Neuropathic bladder
Bowel denervation
Scoliosis
Hydrocephalus

44
Q

How is hydrocephalus treated?

A

Ventriculoperitoneal shunt

45
Q

Outline the management of idiopathic intracranial hypertension.

A 
Eliminate causal factors 
Weight-reduction 
Low-sodium diet and fluid restriction 
Acetazolamide
Analgesia
VP shunt
46
Q

List some clinical features of a child at high-risk of sepsis.

A 
Behaviour:
•	No response to social cues 
•	Appears ill
•	Does not wake, or if roused does not stay awake 
•	Weak, high-pitched and continuous cry

Heart Rate:
• Tachycardia (different at different ages)
• < 60 bpm at any age

Respiratory Rate
•	Tachypnoea (different at different ages)
•	Grunting 
•	Apnoea
•	SpO2 < 90% on air
Mottled or ashen appearance 
Cyanosis of the skin, lips or tongue
Non-blanching rash 
Aged < 3 months with temperature > 38 degrees 
Temperature < 36 degrees
47
Q

Which investigations constitute a septic screen?

A 
FBC 
Blood culture 
CRP 
Urinalysis 
LP 
CXR

Also do a VBG

NOTE: if < 1 month, all children should have an LP

48
Q

Outline the role of a VBG in managing a child with moderate to high risk of sepsis.

A

> 2 mmol/L or evidence of AKI –> treat as high-risk

< 2 mmol/L = repeat assessment at least hourly, ensure review by senior clinician, identify a cause and manage it

49
Q

Outline the non-pharmacological steps taken in the management of high risk sepsis.

A 
Immediate review by senior clinician 
VBG (gas, glucose, lactate, FBC, U&E, creatinine, clotting)
Broad spectrum antibiotics immediately
Monitor continuously 
Monitor mental state using GCS or AVPU
50
Q

Outline how the lactate guides treatment in high risk sepsis.

A

> 4 mmol/L = IV fluid bolus without delay, refer to critical care
2-4 mmol/L = IV fluid bolus without delay
< 2 mmmol/L = consider IV fluids

YEAR 5: Specialties (12 decks)

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