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PACES written cases morris et al > Paeds > Flashcards

Paeds Flashcards

1
Q

Acute Asthma Attack

History

A

HPC - timeframe, cough, wheeze
PMH - previous attacks, developmental, allergies
Social history - exacerbations

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2
Q

Acute Asthma Attack

Differentials

A

Foreign body
PE
Pneumothorax
Pneumonia

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3
Q

Acute asthma attack

Impending resp failure

A 
Exhaustion
no speaking
colour
hypoxia despite oxygen
Silent chest
Tachy
Drowsiness
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4
Q

Acute Asthma Attack

Exacerbation scale

A

Moderate - over 92 sats, absence of severe symptoms.
Severe - <92sats, no tealking, HR >130, RR>50, accessory muscles
Life threatening - <92 sats PLUS colour, conscious, agitaiton, resp effort, silent chest

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5
Q

Acute Asthma Attack

Moderate Treatment

A

B2 agonist 2-10 puffs VIA SPACER plus facemask
reassess afer 15 mins

Responding - 1-4hrls salbutamol
Give prednisolone sluble orally

Not responding - repeate B2 agonist, prednisolone, admit

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6
Q

Acute Asthma Attack

Severe - Treatment

A

nebulised B2 agonist 2.5mg (5 if over 5) salbutamol/terbutaline 5mg (10 if over 5)
02 via face mask
Soluable prednisolone 20mg or IV hydrocortisone

not responding - ipatropium bromide 0.25mg
- bolus IV salbutamol

X-ray, bloods

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7
Q

Acute Asthma Attack

Discharge

A 
continue B2 agonist 4 hrls
predniolone daily for 4days @20mg
PROVIDE WRITTEN ASTHMA PLAN
REVIEW REGULAR TREATMENT
Arrange GP follow up
check inhaler technique
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8
Q

Acute Asthma Attack

Management summary

A 
ABC
obstruction
hf oxygen
start regular inhaled beta agonist via nebuliser
cardiac monioring- why?
oral pred/IV hydrocortisone
Blood gases and cx ray
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9
Q

Acute Asthma attack

Discharge quesitions

A

How often does he miss his regular drugs?
• Is there parental supervision?
• What device does he use? Children rarely use
• Consider changing to a combined steroid/long-acting β-agonist inhaler.

• Ask about smoking – him and his family. Adults should be encouraged to
stop smoking or to smoke outside.
• Educate about allergen avoidance, e.g. daily vacuuming to reduce house
dust mites. Consider measuring total IgE and specific allergen IgE (RAST)
if the history suggests allergies.
• All asthmatics should have a written home management plan.
• Provide an asthma symptom diary and arrange hospital follow-up until
control improves. Most children can and should be managed in primary
care. Primary care and hospital-based asthma specialist nurses are very
helpful.

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10
Q

ADHD (3 pillars)

A

Inattention
hyperativity
Impulsiveness

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11
Q

ADHD further quesitons

A 
Chronology of symptoms
How evolved across 3 pilars
School behaviour
Family and socail history
bedtime routine
mothers concern/agenda
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12
Q

Differentials of ADHD

A

Learning difficulty from hearing impariement
Psychosocial involvement in developement
Antisocial behaviour disorder
Thyrotoxicosis

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13
Q

ADHD management

A 
behaviour modifying 
- structured environment
- reinforcement
- self control 
educational
- classrom help

Drug treatment -ritalin

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14
Q

Ritalin side effects

A

growth
hypertension

requie a drug holiday once a year

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15
Q

Anaphylaxis

Differentials

A

Acute Exacerbation of asthma

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16
Q

Anaphylaxis Tests

A

Blood gas and bloods

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17
Q

Anaphylaxis

Management

A

CONSTNAT OBS

ABC
Breathing oxygen and neb salbutamol
IM adrenaline 10ug/kg
Circulaton - 20ml/kg of 0.9% saline as in shock

repeat every 5 mins if no improvement

18
Q

Anaphylaxis tx once stabe

A

IV hydrocortisone
IV chlorpheniramine

Skin prick
serum IgE
RAST tests

All done a wek after last steroid given

19
Q

Anaphylxis discharge

A

Conservaitve- food avoidance
Medical - oral anthistmaines
- IM adrenaline pen
- how to use

MDT - paediatrician for allergen
dietician
educate - family and school

20
Q

Appendicitis (differnetials)

A 
-Gastro
Appendicitis
Obstruction
Mesenteric adenitis
Gastroenteritis
Crohns
Hepatitis

DKA

Psychological

Urinary - UTI

Gynae
 - Ovulation pain
ovarian cyst
ectopic
PID

Testicular torsion for male

21
Q

Appendicitis Ivx

A 
FBC
inflammatory markers
LFTS
Dip urine
Imagine
Pregnancy Tesyt
22
Q

Appendicits management

A

Medical
- Fluids and Abx

Surgical
Admission for surgicla opinon
- N.B.M
Appendectomy.

23
Q

Causes of acute abdo pain

A

Surgical
Medical
Extra abdominal

24
Q

Surgical Causes of acute abdo pain

A 
Appendicitis
intestinal obstruction
Inguinal hernia
Peritonitis
Inflamed Meckel deverticulum
Pancreatitis
Trauma
25
Q

Medical Causes of acute abdo pain

A 
Gastroenteritis
Urinary
- UTI
- Acute pyelonephritis
- hydronephrosis
- renal calculus
henlock Schon purpura
DKA
Sickel Clell
Hep
IBD
Constipation
Psych
Gynae
Lead posionin
porphyria
26
Q

Extra abdominal Causes of acute abdo pain

A

URTI
Lower lobe pneumonia
Torsion of the testis
Hip and Spine

27
Q

Asthma

Atopic associated with

A

IgE

28
Q

Asthma presentaiton

A

SOB, cough and wheeze

Worse at night/early morning
Triggered
Interva;
family histroy
resonds to therapy
29
Q

Asthma questions

A

onset and associated symptoms
foreign body inhalation
previous history of wheeze
Atopy

30
Q

Asthma differentials

A

Inhaled foreign body
Viral LRTI
Bacterial LRTI
Pneumothorax

31
Q

Asthma management

A

B2 agonist with spacer
2-10 puffs
Consider soluable prednisolone

32
Q

Two types of wheeze

A
  1. Transient early wheezing

2. Persistent and recurrent wheezing

33
Q
  1. Persistent and recurrent wheezing
A

Atopic asthma (IgE assoc.)- common inhalant allergens. Assoc with
eczema, food allergy and hayfever.
o Non atopic asthma

34
Q

Transient early wheezing

A

small airways being become narrow and
obstructed due to inflammation after viral infection. Gives condition it episodic
nature. Decreased lung function from birth due to premature or maternal
smoking

35
Q

Asthma Aetiology

A
  1. Bronchial inflammation
    Oedema, excessive mucus production and cell infiltration
  2. Bronchial hyperresponsiveness
  3. Airway narrowing
    REVERSIBLE airflow obstruction
  4. Symptoms e.g. Wheeze, cough, breathlessness and chest tightness
36
Q

Asthma risk factors

A

Genetic

Atopy (associated conditions)

Environmental triggers
House mite, pollens, pets, cold air, anxiety

37
Q

Asthma investigations

A

CXR to rule out differentials
Peak flow diary
PEFR - before and after treatment

38
Q

Types of inhaler

A

pMDI- younger age
o Dry powder- +4 years
o Metered dose inhaler - +6 years
o Nebuliser- emergency only

39
Q

ASD differentials

A 
Learning difficulty
Psychiatric depression
Anxiety disorder
OCD
Dyslexia
ADHD
40
Q

ASD diagnosed on

A

speech and language disorder
social interaction
ritualistic and repetitive behaviour

41
Q

ASD management

A

Conservative
- Psychosocial play - attetion, engagement, communication
lie skills - coping strategies, lesure and emplyment facilities
interventions for othe disorders

AIMS

  • Reduce ritualistic behavious
  • Develop language
  • Develop social skills

Medical - help sleeping

MDT approach

PACES written cases morris et al (2 decks)

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