Paeds Flashcards
1
Q
Causes of acyanotic congenital heart disease
A
ASD VSD PDA Coarctation of aorta Isolated valve lesion Aortopulmonary window
2
Q
What is reversal of a acyanotic L to R shunt to a cyanotic R to L shunt called?
A
Eisenmenger’s syndrome
3
Q
Causes of cyanotic congenital heart disease
A
Tetrology of fallot's Transposition of great arteries Tricuspid or pulmonary atresia Hypoplastic left heart Univentricular heart
4
Q
What do cyanotic conditions such as tricuspid atresia and transposition of the great arteries require to be viable?
A
A shunt, either an ASD, VSD or PDA
5
Q
S+S of VSD
A
Mild symptoms
Harsh blowing pansystolic murmur +/- thrill (widespread but especially left sternal edge)
6
Q
ECG and CXR findings in VSD
A
ECG - normal progressing to LVH
CXR - pulmonary engorgement
7
Q
Prognosis and management of VSD
A
20% close by 9 months
Large may need surgery
8
Q
S+S of ASD
A
Usually asymptomatic
Widely split S2 and systolic pulmonary flow murmur (left sternal edge 2nd ics)
9
Q
Signs of decompensation in a child with congenital heart disease?
A
Heart failure (sob, hepatomegally, jvp, tachycardia)
Acidosis
Failure to thrive
Poor feeding
10
Q
Standard advice to patients with congenital heart disease
A
Avoid competitive sport and contact (relevant to most)
Ensure good dental hygiene
Avoid tattoos and piercings
11
Q
ECG and CXR findings of ASD
A
RVH +/- RBBB
Cardiomegally / globular heart
12
Q
S+S of PDA
A
Failure to thrive Pneumonia CCF Thrill Systolic pulmonary murmur or continuous hum
13
Q
ECG findings of PDA
A
LVH
14
Q
Prognosis and management of PDA
A
Usually spontaniously closes in a couple of weeks
If distress or compromise - treat CHF, IV indomethacin or ibuprofen to close
Catheter occlusion or surgical ligation
15
Q
What must be done before closing a PDA?
A
Ensure no other cardiac defects - eg pulmonary atresia, which may rely on the PDA for function
16
Q
S+S of coarctation of the aorta
A
Decreased femoral pulses
Raised arm BP
Systolic murmur left upper sternum
Heart failure
17
Q
When do symptoms of coarctation of the aorta tend to occur?
A
Day 2-10 post birth as the DA closes
18
Q
Components of tetralogy of fallot?
A
RVH
Overriding aorta
Right ventricular outflow tract obstruction (pulmonary stenosis)
VSD
19
Q
S+S of tetralogy of fallot
A
Cyanosis
Dysponea
Faints
Squatting (increases pvr so decreases r-l shunt)
20
Q
Treatment of suspected fallots tetrad
A
O2 Knees to chest Morphine to sedate Beta blockers Surgical repair
21
Q
What is ebsteins anomaly
Effect?
A
Downward displacement of tricuspid valve
Atralises right ventricle causing RHF
22
Q
A patient with duct dependent cyanotic heart disease needs their duct kept open! How is this done?
A
Administration of alprostadil
23
Q
What is an example of a benign murmur in a kid? Other terms? What are the features?
A
Stills murmur.
Flow murmur. Functional murmur.
Lack of worrying signs (heaves, thrills, chf, clubbing, cyanosis, arrhythmia, failure to thrive), grade 1/2 only, normal variable splitting of S2, vibratory or musical, lower left sternum, decreased on standing or arching back
24
Q
What congenital defects would cause fixed splitting of S2?
A
ASD
25
What congenital defects would eliminate splitting of S2
Fallots
Pulmonary atresia
Pulmonary stenosis
Transposition of great arteries
26
Initial end of bed assessment for paeds
PAT triangle
Appearance
Work of breathing
Circulation to skin
27
Assessment of young childs appearence (pneumonic)
```
TICLS
Tone
Interactiveness
Consolability
Look/gaze
Speech/cry
```
28
Heart rate changes from infant to adolecent
```
Infant 100-160
Toddler 90 - 150
Preschooler 80-140
School aged 70-120
Adolescent 60-100
```
29
Resp rate changes for age of paed
```
Infant 30-60
Toddler 24-40
Preschooler 22-34
School aged 18-30
Adolescent 12-16
```
30
Systolic blood pressure changes with age (minimum)
```
Infant >60
Toddler >70
Preschooler >75
School aged >80
Adolescent >90
```
31
Average newborn temperature?
37.5
32
Airway/head changes in paeds vs adults
```
Short neck and small mandible
Large head
High u-shaped epiglottis
Large posterior tongue
Narrowest at cricoid
Large tonsils
```
33
Normal developmental milestones of an infant (0-1yr) (not social)
6 weeks - smile
12 weeks - lifts head
5 months - reaches for and holds objects (palmar grasp), rolls over
6 months - sounds, passes things between hands, sit supported
7 months - responds to voice
8 months - sits unsupported, raking grasp
9 months - teething, crawls, pulls self upright, pincer grasp
11 months - hands things over or drops them
12 months - simple words, responds to name, may be able to walk
34
Normal developmental milestones in 2nd year of life (not social)
15 months - tries to feed self, tries to change clothes
18 months - walk unaided, interested in words, builds with bricks
24 months - kicks or throws a ball, at least 2 words together
35
Developmental milestones above 2 years (not social)
4 - Talks well in sentences, draws recognisable person, bladder control,
5 - holds a crayon, uses a knife and fork
36
When should a baby wean onto solids?
4-6 months
37
How much mild should a baby have per day? ml and oz
150ml/kg/day
| 5oz/kg/day
38
How long would a baby generally latch for in breast feeding?
15 minutes
39
What proportion of neonates develop jaundice?
60%
40
What is the major complication of neonatal jaundice? Presentation?
Kernicterus (encephalopathy)
Lethargy, poor feeding, hypertonicity, shrill cry,
Long term sequela of movement disorders and deafness
41
How can bilirubin levels be tested in neonates?
Transcutanious bilirubin levels after 24 hrs life if above 35 weeks gestation. If before either use serum levels. Confirm high readings with serum levels
42
What are the causes of physiological neonatal hyperbilirubinaemia?
Increased amounts of haemoglobin
Increased bilirubin production due to short rbc lifespan
Hepatic immaturity decreasing bilirubin conjugation
Lack of gut flora decreasing elimination (less steatobillagen so more urobillagen reabsorbed)
43
What are the characteristics of physiological neonatal hyperbilirubinaemia?
Onset after 24 hours
| Gone by 14 days
44
Other than timing, what would suggest a neonatal jaundice was pathological?
```
Rapidly rising bilirubin
Very high bilirubin
Steatorrheoa
Billirubinurea
Unwell
```
45
Causes of jaundice within 24 hours?
Sepsis
Rh haemolytic disease or ABO incompatibility
Red cell disorder
46
What leaves a neonate at risk of sepsis in the first 24 hours?
Membrane rupture >24 hrs prior to delivery
Mother GBS +ve
Chorioamnioitis (discoloured amniotic fluid)
Prematurity
Maternal UTI
47
History and investigations in a neonate with jaundince before 24 hours
Risk factors for neonatal sepsis
FBC, Film, Group, Coombs test
TORCH screen, consider cultures (blood, urine)
Consider testing for G6PD deficiency
48
Causes of jaundice over 14 days post birth in a neonate?
```
Dehydration (often 2o to insufficiant breastfeeding)
Sepsis
Hypothyroidism
Cystic fibrosis
Billiary atresia
Hepatitis
Prolonged haemolysis (e.g. Malaria)
```
49
How would a neonate with billiary atresia present differently to one with other causes of neonatal jaundice?
Steatorrheoa and high conjugated bilirubin as opposed to unconjugated
50
Treatment options for neonatal jaundice? Brief mechanism
Phototherapy - light converts bilrubin to soluble form allowing excretion
Exchange transfusion - removal of fetal blood replacing with donated blood to remove the toxin
51
Complications of neonatal phototherapy
Temperature change
Eye damage
Diarrhoea
Fluid loss
52
When would exchange transfusion be considered in hyperbilirubinaemia in a neonate?
Active haemolysis
Level above the transfusion line
Features of encephalopathy
53
Side effects of neonatal exchange transfusion
Bradycardia, thrombocytopenia, hypoglycaemia, hyponatraemia, decreased SpO2 (due to loss of HbF)
54
What factors suggest that a baby is at risk of significant hyperbilirubinaemia
Premature
Sibling has had jaundince needing phototherapy
Mother intends to breastfeed exclusively
Onset within 24 hours
55
Commonest cause of gastroenteritis in paeds?
Rotavirus
56
Causes of paediatric acute diarrhoea with pertinent history/examination/complications?
Viral
Bacterial - Hx: travel, dodgy foods, blood - comp: HUS
Appendicitis - O/E: rebound tenderness etc.
Intersusseption - Hx: blood
Constipation!
57
Examinations in benign sounding D+V in paeds prior to discharge?
Fluid challenge to ensure they can stay hydrated
58
Investigations of chronic diarrheoa in a paed with relevant causes
```
TFTs - thyrotoxicosis
Infection - stool culture
Coeliac screen - coeliac
Trial without cows milk - cows milk protein allergy
Trial without milk - lactose intolerance
Hx/OE - constipation, surgical
Fecal calprotectin - IBD
Exclusion: IBS
```
59
What is the cause and presentation of HUS?
Usually follows ecoli 0157 infection - though can be other bacteria or even without infection. Linked to a toxin released by the bacteria.
Presents with haemolytic anaemia, uraemia and kidney failure, low platelets along with organ dysfunction and encephalopathy. Usually a week or so after an episode of bloody diarrheoa
60
Treatment of HUS
Supportive. Including transfusion and dialysis
61
Causes of petechia in paeds and differentiating factors
Severe vomiting/coughing - distribution of SVC only
HSP - buttocks and back of legs +/- joint and abdo pain
Viral infection - including enterovirus and influenza
Meningococcal septicaemia - bloody poorly
Thrombocytopenia (ITP, leukaemia) - low platelet count
64
How do UTIs present differently in children vs adults?
As unable to convey symptoms when very young often present with sepsis, collapse, D+V, failure to thrive or colic.
65
What percentage of children with UTIs have an anatomical defect? Which?
35% have vesico-ureteric reflex
15% have renal scarring - usually as a result of above
5% have stones
66
How can urination be induced in an infant to get a clean sample?
Wash the genitals
| 1 hr post feed tap over the bladder
67
In an unwell child who needs a urine sample taking what technique could be considered?
Supra pubic aspiration
68
Investigations in first uti in a child?
Dip, msc
| USS (though low sensitivity)
69
If recurrent utis in children what tests should be considered? What treatments?
Technetium renography (for scarring) - dmsa
70
Good test to monitor level of IBD and response to treatment?
Fecal calprotectin
71
Why are frequent exacerbations of IBD especially bad for children?
Require steroid therapy stunting growth
72
What often occurs between exacerbations in UC but not crohns that may mimic an exacerbation?
Constipation resulting in pain and overflow diarrheoa
73
When should merconium usually be passed by post delivery? When are we concerned? How does this change in premature neonates?
24hrs
48hrs
Delayed
74
When should merconium swap to be normal stools?
Day 4
75
Causes of delayed merconium passage?
```
Meconium ileus
Duodenal atresia
Malrotation
Volvulus
Hirchsprungs
Anorectal malformation
```
76
Other than delayed passage of merconium, other red flags of constipation in pades?
```
In first few weeks of life
Faltering growth
Weakness or slow reflexes in legs
Delayed walking
Abnormal appearing anus or sacral skin
Abdominal distension with vomiting
```
77
Causes of constipation in paeds
```
Diet and fluid intake
Perianal disease leading to reluctance
Cycle of hard stools to pain to harder stools to more pain
Behavioural
Hirschprungs disease
Anorectal malformation
```
78
What is hirschsprungs disease?
Congenital absence of ganglia in segment of colon, usually starting rectally. Can progress through small bowel.
79
Diagnosis, treatment and complication there of of hirschsprungs disease
Biopsy
Bowel resection +/- colostomy
Short bowel syndrome
80
What is and presentation of gut malrotation
Failure of gut attaching to mesentery resulting in volvulus or obstruction by fibrotic bands. If necrotic pr bleeding.
Neonatal billious vomiting and failure to pass merconium
81
Presentation of pyloric stenosis?
Projectile non billious vomiting within minutes of a feed
At 3-8 weeks
Malnutrition or dehydration often
82
What signs are visible post feed in pyloric stensosis
Left to right peristalsis in luq
| Olive sized pyloric mass on left side
83
Metabolic abnormalities commonly seen in pyloric stenosis
Hyponatraemia
Hypocholoraemia
Hypokalaemia
Metabolic alkalosis
84
Tests for pyloric stenosis
Uss
85
Management of pyloric stenosis
Correct electrolyte disturbance
Ng tube
Surgery
86
Commonest cause of intestinal obstruction in children?
Intussusception
87
Commonest age range of intussusception? Gender? Presentation?
5-12 months, male
| Episodic incosolable crying, colic (drawing legs in), vomiting and pr blood
88
Examination of a infant with intussuseption
Abdominal mass and may be shocked
89
Managment of intussuseption
Ng tube
Air enema
Surgery
90
In severe constipation what surgical technique may help?
```
MACE
Malone
Antigrade
Continence
Enema
```
91
Contraindications to breast feeding
Hiv
Some chemo drugs
Amiodarone
Antithyroid drugs
92
Benefits of breast feeding
```
Bonding
Immunity
Decreased infant mortality
Decreased dm, ra, ibd and atopy
Mother looses weight
Decreased maternal ca breast
Higher iq
Cost - milk and steralising
Convenience
```
93
First breast milk? Difference?
Colostrum
| Very high antibody and protein content
94
How long should a baby be breast fed for exclusivly?
6 months.
95
How much would you expect a newborn baby to feed?
```
D1 - 50ml/kg/d
D2 - 75
D3 - 100
D4 - 125
D5 - 150
```
96
How should a baby under 28 weeks gestation be fed
By ng tube as no suck reflex
| Preferably with expressed breast milk maybe with breast milk fortifier
97
Risk factors for neonatal hypoglycaemia
```
Maternal diabetes
High or low birth weight
Preterm
Septic
Labetalol in mother
Incurrent illness
Steroid deficient (eg CAH)
Metabolic disorder (eg glycogen storage disease)
Polycythemia
```
98
What happens to a babies hb concentration over the first year of life? Why?
Initially high as transfusion from cord - aprox 18
Drops due to haemolysis and lack of epo to a low of 8-10 at 6 months
Epo kicks in and raises to adult levels by about 1
99
At what bm thresholds should a newborn be treated?
Aim to maintain prefeed level >2
| If treating aim for 2.6
100
When should a newborn be treated for hypoglycaemia actively?
If symptomatic
| BM <1.1
101
What dose of iv dextrose to use in a neonate?
3ml/kg iv 10% dextrose bolus
| Maintenance at 75ml/kg/day
102
Advice when counselling use of epipen to parents or patient?
```
Familiar with signs and symptoms
Remove cap
Hold in clenched fist
Inject into thigh holding in for 10 seconds
Rub area
Dial 999
```
103
What is the prognosis of a cows milk protein allergy?
20% outgrow by 1, most by 3
104
What other allergies may children with cows milk protein allergies have?
Goat and other mammal milks
| Soy milk
105
What are the two main categorisations of cows milk protein allergy? Presentations?
IgE with immediate response - urticaria, oedema, vomiting, diarrhoea, wheeze, sob, cramps, anaphylaxis
Non IgE with delayed response - poor feeding, colic, back arching, diarrhoea, bloody stools, constipation, failure to thrive
106
How is a ige mediated cows milk protein allergy diagnosed?
Allergy skin prick testing
107
How is a non ige cows milk protein allegy diagnosed
Removal for 6 weeks relieves symptoms and reintroduction causes them to return.
108
Treatment of cows milk protein allergy?
Avoid cows milk! Replace with hypoallergenic formula.
| Epipen if severe
109
Symptoms and signs of a runny nose!
```
Runny nose
Sniffling and snorting
Wiping upper lip
Sore throat
Cough
Stomach ache
```
110
Signs and symptoms of blocked nose
Sniffing
Rubs nose
Mouth breaths
Snores and poor sleep
111
Characteristic of inflammed nasal mucosa
Pale!
112
What are the characteristics of pollen food syndrome?
Allergic reaction to foods due to cross reactivity with pollen proteins
Worse during hayfever season
Can often tolerate cooked foods as proteins denatured
Symptoms limited to mouth and throat as stomach acid denatures
113
What age range tends to get pollen food syndrome?
Teenagers to adults
114
Symptoms of a pollen food allergy
Mouth itching or burning
| Swelling of lips and moth
115
Prevalence of nut allergy?
1-2%
116
Risk factors for nut allergy?
FHx
Atopy
Egg allergy
117
Does a pregnant women eating nuts raise or lower the risk of offspring having a nut allergy?
Neither - no effect
118
Dose early introduction of nuts to a diet raise or lower the risk of a nut allergy?
Lower
119
Do peanut allergic patients react to other legumes?
Not commonly, only 5%
120
If you are allergic to one tree nut what is the risk you will be allergic to another?
40%
121
What advice is prudent to give a nut allergic child about 'may contain nut' labels?
There is a risk but it is low. Cutting them out is likely to severely limit your diet. Be sensible - dont eat if you feel unwell (e.g asthma is playing up) eat if you want but make sure you have and epipen and are somewhere help could get too fast
122
Prevalence of egg allergy in under 5s
1-2%
123
Prognosis of egg allergy?
Generally passes with age but some stay allergic into adulthood
124
How can eggs be reintroduced into the diet of an egg allergic patient?
```
Supervised challenge (if very allergic or atopic) then slowly e.g.
Start with biscuit crumbs, then biscuit, then cake, then well cooked egg, then scrambled egg, then mayonnaise
```
125
What vaccines should be avoided in egg allergic patients
Rabies
Yellow fever
Flu - though has been shown to be safe as very small amounts
126
What medication is used early in the management of paediatric asthma?
Monteleukast
127
Differences between infant and adult xray
Infants more triangular shape
Flatter diaphragm due to more superior insertion
Presence of thymus
Flatter ribs
128
How can respiratory distress be inferred on a paediatric xray?
Anterior ribs superior to inferior in superior chest from pulling
Large amount of air in stomach from gasping
129
What causes respiratory distress syndrome?
| Risk factors?
Lack of surfactant
| Prem, maternal diabetes, 2nd twin, caesarian
130
Presentation of respiratory distress syndrome
Distress (tachypnoea, grunting, nasal flaring, recession, cyanosis)
Within 4 hrs of birth
131
Cxr signs of respiratory distress syndrome
Ground glass appearing opacity
132
Differential diagnosis of respiratory distress syndrome with one hallmark of each
Transient tachypnea of newborn (resolves in 24 hrs)
Merconium aspiration (merconium stained fluids)
Trachoesophageal fistula (symptoms post feed)
Sepsis (infection risk factors)
133
Treatment of respiratory distress syndrome?
Delayed cord clamp to promote transfusion
Oxygen (lowest possible amount)
CPAP or tube
Surfactant down tube
134
What is necrotising enterocolitis?
| Risk factors
Inflammatory bowel necrosis of uncertain origin
| Prematurity, entral feeding, rapid weight gain
135
Presentation of necrotising enterocolitis?
Distension
Blood or mucus pr
Colic
Shock
136
Patheneumonic sign of necrotising enterocolitis on axr?
Pneumatosis intestinalis - gas in gut wall
137
Treatment of necrotising enterocolitis
Stop oral feeding apart from oral probiotics
Antibiotics
Consider surgery if progressive or perforation
138
A well neonate presents with a macular rash with central white pustules on day 4? What are they? Prognosis?
Erythema toxicum
| Will pass usually in 24 hrs. All gone by day 14
139
A baby appears with what looks like a bruise on the buttock. Parents dont know why its there. Medical differential to nai. And differentiating factors
Mongolian blue spot
| These are present from birth, static and uniform in colour, well defined and should be multiple.
140
What group is more likely to have a mongolian blue spot? Prognosis?
Downs syndrome and afrocarribean
| Lifelong but decrease in intensity with time.
141
A neonate presents with a macular erythenatous rash over brow and back of the neck. What is it? Cause? Prognosis?
Stork mark
Capillary dilatation
Fade with time
142
What is cradle cap? Features?
Seborrhoeic dermatitis
Overactive sebaceous glands
Greasy yellow scaly patch on scalp
143
Treatment of cradle cap
Massage with olive oil
Water based creams
Avoid shampoo
144
A baby presents with a papular rash on their forehead and upper lip, with clusters of clear vesicles mms across. What is it? Cause?
Milia acrystalina
| Blockage of pilosebaceous glands
145
Other than acrystalina what other variants of milia exist? How do they appear
Rubra - blocked sebum - milky
| Nigra - gunk - black
146
Presentation of nappy rash. Commonest complication?
Erythematous with spots, blisters, sores and dry skin in nappy distribution. Can be painful but usually not. Ripe for infection as dark moist and warm.
147
Cause of a petichial rash? Distinguishing features?
```
Vomiting or coughing - only on upper trunk and face
Meningococcal septicemia - very unwell
Viral infection - coryza etc.
Thrombocytopnea - low platelets
Vasculitis - e.g. Hsp distribution
```
148
Mangement of uncomplicated nappy rash
Change nappies often
Clean area thoroughly with baby wipe
Bath no more than once a day
Dry thoroughly post wash
Leave baby out of nappy for periods of time
Refrain from use of soaps, talcs, bubble baths etc.
149
Commonest infection of nappy rash? Identifying features?
Candidia
| Satellite lesions
150
Treatment of candidia infected nappy rash
10 days of antifungals as well as standard care
151
In candidia infected nappy rash what should be checked to assess for potential source of infection?
Tongue
| Can come from cracked nipple or unsterilised bottle and travel down gi tract
152
What is the patheneumonic feature of molluscum contagiosum? What other features does it have?
Umbillication - central indentation
| Generally a firm papular pustular rash
153
What causes molluscum contagiosum? Treatment and prognosis?
Molliscum contagiosum virus
Individual spots heal in 2 months however they can spread thus infection lasts a lot longer.
In severe cases or if weak immune system tx with cryotherapy, podophyllotoxin, imuiqimod etc.
154
Physical differentials for adhd with how they present and differentiation
Tuberous sclerosis - aggression - shagreen patch
Neurofibromatosis - aggression - cafe au lait spots
Vision/hearing problems - poor communication - vision/hearing test
Anaemia - inattentive - Hb and ferritin
Thyroid - TFTs
155
Mental differentials for ADHD
```
ADD
Poor parenting
Depression/anxiety
Conduct disorder
Autism
```
156
When would a child begin to exhibit hand dominance? What should be thought of if it occurs early?
1yr. If before then think hemiplegia - ?cerebral palsy
157
Changes in child grip with time as an infant
Palmar - rake - pincer (9months)
158
Normal age of starting to walk in a child
12-18 months
159
Normal age of sitting in a child
6months supported
| 9months unsupported
160
How should a 18 month old child play?
Symbolic - imitates behaviour, selfish
161
When should children start to interact with other children and share during play
3-4 years
162
What are the 5 categories of development that should be considered in a child?
```
Gross motor
Fine motor
Social, speech and language
Senses
Self help skills
```
163
How much maintenance fluid should a child be prescribed? What should be used?
100ml/kg/day 1st 10kg
50ml/kg/day 2nd 10kg
20ml/kg/day subsequently
5%dextrose with 0.9%sodium chloride
164
If a child has a 10% volume deficiency whilst unwell how much fluid should be replaced on top of maintenance?
10% of body weight in litres!
165
What are the different sorts of lactose intolerance?
Congenital absence of lactase
1o lactose intolerance due to genetic decreased expression
2o lactose intolerance due to gi disease e.g. Following infection
166
Why does lactose intolerance cause symptoms? What are they?
High lactose broken down by bacteria in gut causing osmotic effect and fermentation
Results in diarrhoea, flatulance, perianal itching and bloating
167
How can lactose intolerance be tested for?
Elimination and re challenge
Hydrogen breath testing post milk feed
Intestinal biopsy?
168
Severe complication of cows milk protein allergy? Presentation? What does it mimic?
Food protein induced enterocolitis syndrome (fpies)
D+V
Third space loss
Severe dehydration and shock
Mimics sepsis
169
What sort of reaction is fpies (food protein induced enterocolitis syndrome)? Consequence of this for diagnosis?
Non-ige
| Negative skin prick testing
170
Treatment options of croup (inc conservative and severe)
```
Keep calm
Paracetamol if in pain (likely)
Dexamethasone
Nebulised adrenaline
Intubation and ventilation
```
171
What is the usual demographics of bronchiolitis? What is important about when it occurs? Signs and symptoms? Course?
Usually
172
Cause of bronchiloitis
| Treatment? Include conservative
Usually rsv
Conservative (paracetamol, fluid, sit up etc)
Medical (ng tube, oxygen etc)
173
What antibiotics should be used in a paediatric patient with community acquired pneumonia?
Cefuroxime and clarythromycin
174
How should clarythromycin be given in an ill paediatric patient with a pneumonia?
Orally! It damages veins
175
Causes of stridor
```
Croup
Laryngitis
Epiglottitis
Foreign body
Congenital
Tumour
Trauma
Anaphylaxis
```
176
How can the severity of croup be graded?
1 - inspiratory stridor and barking cough
2 - + expiratory stridor
3 - + pulsus paradoxus
4 - + cyanosis or confusion
177
Commonest cause of croup
Parainfluenza usually. Can be bacterial but unusual
178
Main congenitial cause of stridor
Presentation
Prognosis and tx
Trachomalacia - floppy glottis and aryepiglotic folds
Onset of inspiratory stridor hours to months after birth. Worse when asleep
Usually resolves by 2 but may need surgery
179
What would suggest epiglotitis over croup?
```
Sudden onset
Continous stridor
Soft stridor
Drooling
Muffled voice
Septic
Not much of a cough
```
180
What is the presentation of bacterial tracheitis in comparison to croup?
Fails to respond to croup therapy
Continuous often biphasic stridor
Septic
181
What would the cxr findings of a patient with a congenital diaphragmatic hernia be immidiately post delivery?
White out as no gas in bowels until you start to swallow!
182
In paediatric patients what is a good sign of RHF?
Hepatomegally
183
A smooth hump is seen on the cxr of a dysponic neonate. Potential cause?
Eventration of diaphragm
184
What conditions should be assessed for on the skin of a child with developmental / behavioural problems? What are the signs
Neurofibromatosis - cafe au lait
Tuberous sclerosis - harmatomas, shagreen patch, ash leaf marks
Pseudohyperparathyroidism - calcium deposits
185
What is tuberous sclerosis? Inheritance?
A genetic condition causing benign tumours to grow in brain, skin, kidneys, heart, eyes, lungs
3/4 spontanious
1/4 autosomal dominant
186
Main problems with tuberous sclerosis
```
Epilepsy
Learning difficulty
Behavioural problems /asd
Skin abnormalities
Kidney problems
Breathing difficulty
Hydrocephalus
```
187
What loss of bowel would lead to short bowel syndrome?
50-70%
188
What are the stages of short bowel syndrome?
Acute - malnutrition and fluid/electrolyte loss
Adaption - improving absorption
Maintainance - plateau
189
S+S of short bowel syndrome
Failure to thrive
Diarrhoea
Fatigue/malaise
Deficiencies
190
What specific symptom may be present in short bowel syndrome with loss of the ilium?
Steatorrhoea
191
Causes of short bowel syndrome
Surgery
Congenital
Extensive bowel pathology
192
Treatment of short bowel syndrome
Paraentral nutrition
Artificial bowel
Bowel transplant
193
Extra items of a paed history
Birth
Feeding
Immunisation
Development
194
What vaccines should a child have in first year of life?
Pneumococcal
Meningitis B and C
Rotavirus
5in1 (tetnus, diptheria, HIB, pertussis, polio)
195
What additional vaccinations are given at one year
MMR
196
What additional vaccines do children receive between 2 and 6
Annual flu
197
What vaccines do teenagers receive?
HPV
| Meningitis ACWY
198
What conditions mimics newborn rspiratory distress syndrome? Risk factors?
Transient tachypneoa of the newborn - csection
| Aspiration pneumonia - merconium staining
199
Categories of abuse in paeds
Emotional
Physical
Neglect
Sexual
200
When does a febrile convulsion become complex?
More than 15 mins
Reoccur within 24 hours
Affect only one side off the body.
More than 1 hour post ictal
201
When should a parent dial 999 in a case of a seizing child known to have febrile convulsions?
After 5 mins of seizing
202
What age ranges do febrile convulsions usually occur in? Whendo they become rare?
6months to 3 years
| Rare over 6 years
203
When in an illness does a febrile convulsion usually occur?
Early - as the temperature is rising
204
Do antipyretics help febrile convulsions?
No
205
Conservative advice for tx of febrile child at risk of convulsions
Remove clothing
Fan to cool room
Plenty of fluids
206
Long term risk of epilepsy in child with febrile convulsions?
1:100
