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Paeds Flashcards

1
Q

Give hx structure in paeds minus developmental hx

A
  1. PC + HPC:
    a. Feeding - volume + frequency
    b. Vomiting
    c. Fever
    d. Wet nappies?
    e. Stools - consistency and look
    1. PMH:
      a. Antenatal period
      b. Birth - deliver, premature, birth weight
      c. Neonatal period - illnesses and admissions
      d. Medical conditions
      e. Surgeries
    2. Drug history + allergies
    3. Weight, height & Developmental history (milestones):
      a. 6 weeks - smiles and lifts head
      b. 6 months - rolls over, moves objects hand to hand, social
      c. 8 months - sits unsupported
      d. 12 months - pincer grip, 2 syllable words, stranger anxiety, unstable walking
      e. 15 months - stable walking, points at what they want
      f. 18 months - scribbles with crayons
      g. 2 years - 2/3 word sentences, up & down stairs
      h. 3 years - stands on one foot, counts to 10, can dress and undress
      i. 4 years - hops on 1 foot, toilet trained
    4. Immunisations
    5. Dietary history:
      a. Special requirements
      b. Type of food
    6. FHx
    7. SHx:
      a. Foreign travel
      b. Second hand smoke
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2
Q

Average birth weight

A

3.5kg

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3
Q

when should micturition and meconium occur post birth?

A
  • Micturition - within 24hr

* Meconium - within 48hr

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4
Q

How much milk should a baby have?

A

150 ml/kg per day

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5
Q

Give caloric needs of a 0-1 and 1+ yr old

A

○ 0-1 - 110kcal/kg/day

○ 1yr+ - 1000 + (100xage) kcal/day

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6
Q

Maintenance fluids of child

A

Maintenance fluids:
1st 10kg - 100 ml/kg/day
2nd 10kg - 50 ml/kg/day
Subsequent kg - 20ml/kg/day

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7
Q

Give 3 benefits of breast feeding to mum and baby

A 
Benefits to baby:
	• More easily digested
	• Antibodies that fight infection
	• Lowers risk of allergies
	• Fewer hospitalisations
	• Higher IQ in later life
	• Bonds with mother
	• Lowers risk of SIDS

Benefits to mother:
• Bonds with baby
• Burns calories so lose baby weight
• Releases oxytocin which reduces uterine bleeding after birth
• Lowers risk of breast and ovarian cancer
• Saves money

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8
Q

Paed wheeze differentials

A 
Wheeze:
	• Pneumonia
	• Asthma
	• Bronchiolitis
	• Bronchitis
	• Cystic Fibrosis
	• Inhalation of foreign body
	• Aspiration
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9
Q

Paeds acute cough differentials

A 
Acute Cough:
	• Upper airways:
		○ Rhinovirus
		○ Croup
		○ Allergy
	• Lower airways:
		○ Asthma
		○ Bronchitis, bronchiolitis
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10
Q

Paeds chronic cough differentials

A 
Chronic cough:
	• Upper airways:
		○ Infection - chronic sinusitis, tonsillitis
		○ GORD
	• Lower airways:
		○ Asthma
		○ Foreign body
		○ Bronchiectasis
		○ CF
	• Psychogenic cough
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11
Q

Paeds stridor differentials

A 
Stridor:
	• Nose and nasopharynx:
		○ Inflammation eg rhinitis and sinusitis
	• Mouth:
		○ Tonsillar hypertrophy
		○ Foreign body
	• Larynx:
		○ GORD
		○ Epiglottitis
		○ Abscess
		○ Foreign body
	• Trachea:
		○ Tracheomalacia
		○ Tracheitis
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12
Q

S&S of asthma in paeds

A 
History:
	• Cough after exercise
	• SOB
	• Limited exercise
	• Peak in school age (4)

Examination:
• Barrel shaped chest
• Hyperinflation
• Wheeze and prolonged expiration

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13
Q

Ix of asthma paeds

A

Investigation:
• PEFR <80% predicted
• Bronchodilator response to beta agonist

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14
Q

Tx of asthma paeds

A

Management:

1. ICS + SABA
2. + LABA (>5yrs) or montelukast (<5yrs)
3.  
	a. Response to LABA? - increase
	b. No response to LABA? - Get rid of + increase ICS
4. Increase ICS or + theophylline
5. Daily oral steroid

Consider moving up if using 3+ doses of SABA a week
ALWAYS USE SPACER

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15
Q

S&S of CF

A 
History:
	• Cough and wheeze - recurrent chest infections
	• SOB
	• Sputum
	• Haemoptysis
	• Pale fatty stools - malabsorption
	• Weight loss - failure to thrive
	• Neonates - meconium ileus
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16
Q

Ix of CF

A

Ix:
• Sweat test
• CXR - hyperinflation, infiltrates

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17
Q

Tx of CF

A 
Tx:
	• Non pharm:
		○ Physiotherapy
		○ Annual flu immunisation
		○ High calorie diet
		○ Pancreatic enzyme supplements
		○ Multivitamins
	• Pharm:
		○ Abx ppx
		○ Bronchodilators
		○ Mucolytics
		○ Azithromycin - anti inflammatory and abx
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18
Q

S&S of bronchiolitis

A 
History:
	• Dry cough
	• Wheeze
	• Feeding problems
	• Apnoea episodes
Examination:
	• Resp distress
	• Dry cough
	• Tachypnoea
	• Subcostal and intercostal recession
	• Prolonged expiration
	• Wheeze and crackles
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19
Q

Ix of bronchiolitis

A

Ix:
• Pulse oximetry
• CXR - hyperinflation, patchy change
• Nasopharyngeal swab

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20
Q

Tx of bronchiolitis

A

Tx:
• Oxygen
• If tachypnoea - limit oral feeds and use NGT
• Bronchodilators for wheeze
• Mechanical ventilation for apnoea or severe resp distress

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21
Q

Cause of croup

A

parainfluenza virus

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22
Q

S&S of croup

A 
Symptoms:
	• Barking cough
	• Stridor
	• SOB worse at night
	• Fever
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23
Q

Tx of croup. Epi

A 
Tx:
	• Paracetemol
	• Oral Dexamethasone
	• Adrenaline neb
	• Oxygen

Epi:
• 6 mths to 6 years
• Peak age of 2

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24
Q

Epi, S&S and tx of epiglottitis

A

Epi:
• 1-6 years

S&amp;S:
	• Fever
	• Toxic looking child
	• Stridor
	• Drooling
	• Minimal cough

Tx:
• Urgent review to secure airway
• IV abx

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25
Q

s&s of pneumonia

A

History:
• Fever
• SOB
• Cough

Examination:
• Resp distress signs
• Desaturation and cyanosis
• Dullness to percussion, crackles, decreased breath sounds, bronchial breathing

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26
Q

Ix of pneumonia

A

BOXES

Ix:
	• Sputum
	• Blood culture
	• CXR
	• Pleural fluid if pleural effusion
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27
Q

Tx of pneumonia

A

Tx:
• Amoxicillin or erythromycin
• Severe- co amox
• HAP (48 hrs post admission) - piperacillin with tazobactam

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28
Q

cause of whooping cough

A

bordetella pertussis

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29
Q

S&S, ix and tx of pertussis

A

History:
• Coughing bouts - worse at night and after feeding.
• May vomit
• Inspiratory whoop

Ix:
• Nasal swab culture
• PCR and serology

Tx:
• Azithromycin

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30
Q

CXR finding of neonatal resp distress syndrome

A

CXR:
• Diffuse ground glass lungs
• Bell shaped thorax

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31
Q

Centor criteria and tx

A 
The Centor criteria* are as follows:
	• presence of tonsillar exudate
	• tender anterior cervical lymphadenopathy or lymphadenitis
	• history of fever
	• absence of cough

3+ = cause is Group A beta hemolytic Strep

Tx:
• <3 = Paracetemol
• 3+ = phenoxymethylpenicillin or erythromycin

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32
Q

S&S of HF in paeds

A 
History:
	• Sweating
	• Breathless,
	• Tachypnoea
	• Poor feeding
	• Failure to thrive
	• Tachycardia
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33
Q

Tx of HF in paeds

A

Tx:
• Diuretics
• ACEi

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34
Q

Causes of vomiting acute in paeds

A

○ GI infection
○ GI obstruction eg pyloric stenosis
Poisoning

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35
Q

Causes of chronic vomiting in paeds

A 
• Chronic:
		○ Peptic ulcer disease
		○ GORD
		○ Chronic infection
Gastritits
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36
Q

ix of vomiting in paeds acute and chronic

A

Ix:
• FBCs, U&E, Creatinine
• Stool for culture
• AXR

Chronic:
• +Abdo USS
• +Endoscopy

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37
Q

Causes of constipation paeds

A 
Causes:
	• Commonest - Low fibre, lack of exercise, poor colonic motility (FHx)
	• Hirschprungs
	• Partial obstruction
	• Coeliac disease
	• Infection
	• Hypercalcaemia
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38
Q

Tx for constipation

A

Tx:
• Diet - increase fluid and fibre, natural laxatives eg fruit juice
• Behavioural measures - toilet footrests, regular 5 mins toilet time after meals
• Treat for as long as constipation has been there:
○ Movicol (1st line) or lactulose
○ Enemas if no response

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39
Q

Causes of failure to thrive

A 
Causes:
	• 95% caused by malnutrition
	• Organic causes:
		○ GI problems
		○ GORD
		○ DM
		○ Malabsorption
		○ CF
40
Q

Causes of jaundice

A

Unconjugated causes:
• Hemolysis
• Gilbert syndrome

Mixed causes (liver damage):
• Infection
• Drugs - eg paracetemol OD or TB drugs
• Wilsons disease

Conjugated causes (bile tract obstruction):
• Biliary atresia
• Primary sclerosing cholangitis
• CF

41
Q

Ix of jaundice

A

Ix:
• Liver biopsy
• USS
• Bloods

42
Q

GORD paeds S&S

A 
History:
	• Oesophagitis
	• Failure to thrive
	• Apnoea
	• Regurgitation
43
Q

Ix of GORD and tx

A

Ix:
• Upper GI endoscopy
• CXR
• Barium Swallow

Tx:
• Position babies head 30 degrees above prone
• Avoid food before sleep
• Thicker milk feeds for babies and small frequent meals
• Omeprazole if oesophagitis and gaviscon

44
Q

S&S of gastroenteritis

A 
History:
	• Diarrhoea
	• Vomiting
	• Crampy abdo pain
	• Fever
	• Dehydration
45
Q

ix and tx of gastroenteritis

A

Ix:
• Stool and blood culture
• Sigmoidoscopy if IBD suspected

Tx:
• Rehydration
Consider ampicillin if scoring for sepsis

46
Q

pyloric stenosis hx

A

Presents in weeks 2 - 4 of life with vomiting

History:
• Projectile vomiting, 30 mins after feed
• Constipation and dehydration
• Palpable mass in upper abdomen
• Hyochloremic, hypokalaemic alkalosis due to vomiting

47
Q

Intussesception epi and S&S

A

Epidemiology:
• Affects 6-18 months old.
• 2:1 M:F

S&amp;S:
	• Paroxysmal abdo colic pain
	• Child draws knees up and turns pale
	• Vomiting
	• Blood stained stool
	• Sausage shaped mass in RLQ
48
Q

Ix and tx of intussesception

A

Ix:
• USS

Tx:
• Reduction by air insufflation
• Surgery if signs of peritonitis

49
Q

Allergic colitis patho and S&S

A

Commonest cause of non infective diarrhoea in infants

S&S:
• Diarrhoea with blood and mucus
• Failure to thrive
• Most common allergen is cows milk protein

50
Q

Ix and tx for allergic colitis

A

Tx:
• Exclude allergies from diet and offer substitute

Ix:
• Eosinophilia
• Raised IgE
• Positive skin prick test to specific foods

51
Q

S&S of malrotation

A

S&S:
• Infant - bile stained vomiting
• Older child - GORD, vomiting, abdo pain

52
Q

Hirschprung S&S. ix

A

Presentations:
• Neonatal period - failure or delay to pas meconium
• Bilious vomiting, abdo distension, constipation
• Older children - constipation, abdo distension

Ix:
Rectal biopsy

53
Q

Necrotising enterocolitis S&S

A 
Symptoms:
	• Feeding intolerance
	• Abdo distension
	• Bloody stools
	• Commonly Occurs in neonates <3 months old
54
Q

Coeliac disease S&S and ix

A 
History - Coincides with introduction of gluten in diet:
	• Failure to thrive
	• Diarrhoea
	• Abdo distension
	• Foul smelling stools

Ix:
• Jejunal biopsy showing villous atrophy
• TTG antibodies

55
Q

S&S of meningitis in young and older children

A

S&S:
• Young children - fever, poor feeding, bulging fontaneles
• Older children - headache, neck stiffness, photophobia, kernigs sign

56
Q

Anaphylaxis emergency tx

A

Algorithm - Signs of shock, SOB, or Stridor:

1. High flow oxygen
2. IM adrenaline 1 in 1000, 10 micrograms - repeat in 10-15 mins if no improvement
3.  
	a. If wheezing - Neb salbutamol
	b. If croupy - Neb adrenaline
	c. If systemic symptoms of shock - fluid bolus up to 30ml/kg
4. Antihistamines and oral steroids for 72 hours.
5. Allergy clinic follow up + consider epi pen
57
Q

Tx of UTI in paeds

A

Tx:
• <3 mths old - immediate referral to paediatrician
• >3mths + pyelonephritis - admission
• >3 mths + cystitis - trimethoprim for 3 days + safety net

58
Q

Tx of Minimal change GN

A

Tx:
• Steroids
• Cyclophosphamide if steroid resistant

59
Q

S&S of henoch shenolein purpura

patho

A

S&S:
• Palpable purpuric rash over buttocks and extensors
• Abdo pain
• Polyarthritis
• Features of IgA nephropathy - Haematuria and renal failure

Patho:
• IgA mediated small vessel vasculitis
• Usually seen in children following infection

60
Q

Epi and tx of henoch schonlein purpura

A

Peak - 4-6 yrs

Tx:
• Analgesia for arthralgia
• Supportive tx for nephropathy

61
Q

Undescended testes tx

A

Tx:
• Watch and wait
• If undescended by 9 mths refer to urologist

62
Q

Tx of absence seizure

A

sodium valproate

63
Q

S&S of tuberous sclerosis

A 
S&amp;S:
	• Cutaneous:
		○ Rough skin patches over lumbar spine
		○ Café au lait spots
		○ Depigmented ash leaf spots which fluoresce under UV light
	• Neuro:
		○ Development delay
		○ Epilepsy
		○ Intellectual impaired
64
Q

Ix of tuberous sclerosis

A

Ix:
• CT head
• Gene studies

65
Q

Causes of cerebral palsy

A

Patho:
• Insult to developing brain

Causes:
	• Ischemia
	• Congenital infection
	• Neonatal meningitis
	• Premature
66
Q

S&S of cerebral palsy

A

S&S:
• Spastic - increased tone, reduced power
• Dystonic - involuntary movements
• Ataxic - wide gait, nystagmus, intention tremor

67
Q

Hydrocephalus S&S and ix

A 
S&amp;S:
	• Irritability
	• Poor feeding
	• Headaches
	• Vomiting
	• Seizures
	• Enlarging head size
	• Widened sutures
	• Bulging fontanelles
	• Papilloedema

Ix:
• Cranial CT

68
Q

Febrile convulsions S&S

A

S&S:

• Brief generalised tonic clonic seizure with fever

69
Q

Ix and tx of febrile convulsions

A 
Ix:
	• Urine dipstick
	• Inflammatory markers
	• CXR
	• LP if indicated
	• Consider EEG and brain imaging if concerned

Tx:
• Parental reassurance
• Abx if needed
• BZD if seizure >5 mins

70
Q

S&S of duchennes and ix

A 
S&amp;S:
	• Waddling gait
	• Speech and motor delay
	• Proximal weakness
	• Gowers' sign +ve
	• Muscle wasting

Ix:
• Elevated CK
• Abnormal EMG and nerve conduction
• Muscle biopsy

71
Q

S&S of hand foot and mouth disease and tx

A

History:
• Mild systemic upset - sore throat, small fever
• Oral ulcers
• Vesicles on palms and soles of feet

Tx:
• Hydrate + analgesia
• Reassurance
• No need to exclude from school

72
Q

Patho of hypoxic ischemic encephalopathy and S&S

A

Pathology:
• Neonatal brain injury secondary to asphyxia during pregnancy or labour

S&S:
• Mild - increased tone and reflexes, poor feeding, staring eyes
• Moderate - lethargy, reduced tone and reflexes, seizures
• Severe - coma, reduced tone, multi organ failure

73
Q

Ix and tx of hypoxic ischemic encephalopathy

A

Ix:
• EEG
• MRI brain

Tx:
• Resp and circ support
• Anticonvulsants

74
Q

Cx of prematurity

A 
Cx:
	• RDS
	• Persistent ductus arteriosus
	• Retinopathy of prematurity
	• Sepsis
75
Q

RDS patho, S&S, and tx

A 
RDS:
	• Patho - lack of surfactant in lungs
	• S&amp;S - resp distress, tachycardia, hypoxia, CXR has ground glass appearance
	• Tx - Antenatal steroids, resp support
	• Cx - chronic lung disease
76
Q

PDA patho, S&S, tx

A

Patent ductus arteriosis:
• Patho - left-right shunting, fluid overload –> HF
• S&S - continuous murmur, bounding pulses, wide pulse pressure
• Tx - Fluid restriction, indometacin, surgery to ligate duct
• Cx - HF

77
Q

Retinopathy of prematurity patho, S&S, tx

A 
Retinopathy of prematurity:
	• Patho - Proliferation of frail BVs
	• S&amp;S - asymptomatic
	• Tx - Laser therapy if severe
	• Cx - Retinal detachment, severe visual impairment
78
Q

Causes of first 24 hr jaundice in neonate

A

• Hemolysis eg Rh disease
• Sepsis
Red cell membrane defects

79
Q

Causes of post 24 hr jaundice in neonates

A

day 2-14
Physiological/breast milk
hemolysis, sepsis, red cell defects

2 wks +:
• Unconjugated - breast milk, UTI, hypothyroidism, as above
Conjugated - biliary atresia, neonatal hepatitis

80
Q

Ix of neonatal jaundice

A

FBC, blood group, LFT
Direct Coombs test
TFT

81
Q

Causes of neonatal sepsis

A 
Causes:
	• PROM >24 hrs
	• Maternal sepsis
	• Chorioamnionitis
	• Maternal carriage of GBS
	• Prematurity
82
Q

S&S of neonatal sepsis

A 
S&amp;S:
	• Resp distress
	• Apnoea
	• Poor feeding
	• Temp instability
83
Q

S&S of scarlett fever, tx

A 
History:
	• Fever
	• Malaise
	• Tonsillitis
	• Strawberry tongue
	• Rash - pinhead erythema appearing first on torso and spares face

tx - penicillin v

84
Q

S&S of CNS tumours paeds

A

S&S:
• Early morning headache/vomiting
• Focal neuro signs
• Papilledema

85
Q

Ix and tx of CNS tumours

A 
Ix:
	• MRI brain
Tx:
	• Surgery
	• Chemoradiotherapy
86
Q

What is wilms tumour. S&S

A

Patho:
• Nephroblastoma

S&amp;S:
	• Painless abdo swelling
	• Haematuria
	• Weight loss
	• HTN
87
Q

Ix and tx of wilms tumour

A

Ix:
• CT staging
• Biopsy

Tx:
• Surgical resection
• Chemotherapy

88
Q

S&S and tx of bone tumours

A

S&S:
• Pain
• Swelling
• Pathological fractures of long bones

Tx:
• Surgical excision
• Endoprosthetic replacement

89
Q

Downs syndrome associations

A

hypothyroid, hirschprung, epilepsy, PDA, tetralogy of fallot

90
Q

Cx of turners. chromosomes?

A

Cx:
• Coarctation of aorta
• Infertile
45,X

91
Q

Kleinfelters S&S. chromosomes?

A 
S&amp;S:
	• Tall stature
	• Hypogonadism and small testes
	• Gynaecomastia
	• Behavioural problems

47,XXY

92
Q

S&S of autism

A 
S&amp;S:
	• Delay in speech and language skills
	• Repetitive behaviour
	• Poor eye contact
	• Rigidity of thought
	• Lack of imagination
93
Q

Tx of autism

A

Tx:
• Education
• OT
• SALT

94
Q

Tx of ADHD

A

Tx:
• Methylphenidate
• CBT

95
Q

Tx of breath holding attacks

A

Benign and self limiting

96
Q

developmental hx

A

a. 6 weeks - smiles and lifts head
b. 6 months - rolls over, moves objects hand to hand, social
c. 8 months - sits unsupported
d. 12 months - pincer grip, 2 syllable words, stranger anxiety, unstable walking
e. 15 months - stable walking, points at what they want
f. 18 months - scribbles with crayons
g. 2 years - 2/3 word sentences, up & down stairs
h. 3 years - stands on one foot, counts to 10, can dress and undress
i. 4 years - hops on 1 foot, toilet trained

Z IPE (15 decks)

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