Paeds 5B Flashcards
List the median ages for vision and fine motor milestones.
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
List the median ages for hearing, speech and language development.
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
List the median ages for social, emotional and behavioural development.
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
How is paracetamol overdose managed?
Measure plasma paracetamol concentration at 4 hours and plot on normogram
Treat with IV N-acetylcysteine if necessary
How is carbon monoxide poisoning treated?
Presents with headache, nausea, confusion and drowsiness
High-flow oxygen
Hyperbaric oxygen therapy may be considered
How is salicylate poisoning treated?
Presentation: vomiting, tinnitus, respiratory alkalosis
Measure plasma salicylate concentration at 2-4 hours
Alkalinisation of urine with sodium bicarbonate increases urinary excretion
Consider haemodialysis
How is TCA overdose treated?
Treat arrhythmias and give sodium bicarbonate
Support ventilation
How is ethylene glycol poisoning treated?
Presentation: intoxication, tachycardia, metabolic acidosis
Fomepizole inhibits the production of toxic metabolites (ethanol can also be used)
How is iron overdose treated?
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
How is organophosphorus pesticide poisoning treated?
Supportive Atropine (large dose) Pralidoxime (reactivates actylcholinesterase)
NOTE: presentation is mainly cholinergic features
What is a port wine stain?
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
Describe the appearance and progression of cavernous haemangiomas.
Appears within the first month of life
Grows before shrinking and disappearing (before 5 years)
Describe the inheritance pattern of von Willebrand disease.
Type 1 and 2 = autosomal dominant
Type 3 = autosomal recessive
How should bladder outflow obstruction be investigatd?
MCUG
What are the two different types of polycystic kidney disease and how do they differ?
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
What are the aspects of managing Duchenne muscular dystrophy?
Physiotherapy to prevent contractions
Exercise and psychological support
Surgery (e.g. tendoachilles lengthening)
CPAP for nocturnal hypoxia
Glucocorticoids may slow degeneration
What’s the main difference between Duchenne and Becker muscular dystrophy?
Duchenne - no dystrophin - severe symptoms (LE: 20-30 years)
Becker - abnormal dystrophin - milder symptoms
What are some consequences of neural tube defects?
Paralysis and muscle imbalance (needs physiotherapy)
Sensory loss (can lead to accidental damage)
Neuropathic bladder
Bowel denervation
Scoliosis
Hydrocephalus
How is hydrocephalus treated?
Ventriculoperitoneal shunt
Outline the management of idiopathic intracranial hypertension.
Eliminate causal factors
Weight-reduction
Low-sodium diet and fluid restriction
Acetazolamide
Analgesia
VP shunt
List some clinical features of a child at high-risk of sepsis.
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
Which investigations constitute a septic screen?
FBC
Blood culture
CRP
Urinalysis
LP
CXR
Also do a VBG
NOTE: if < 1 month, all children should have an LP
Outline the role of a VBG in managing a child with moderate to high risk of sepsis.
> 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
Outline the non-pharmacological steps taken in the management of high risk sepsis.
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
Outline how the lactate guides treatment in high risk sepsis.
> 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
