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paeds Flashcards

1
Q

how would you treat croup?

A

oral dexamethasone
consider adrenaline nebuliser for upper airway obstruction
consider the need for oxygen

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2
Q

features of croup

A

stridor
seal like barking cough
respiratory distress
voice hoarseness

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3
Q

what causes croup

A

inflammation of the upper airway usually as a result of parainfluenza virus 1 or 3
peak season is late autumn

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4
Q

who gets croup

A

children aged 6 months - 6 years

male > female

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5
Q

croup differentials

A

epiglottitis
bacterial laryngotracheitis
foreign body inhalation

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6
Q

what are the features of epiglottitis and what causes it?

A

high fever, drooling, sore throat, toxic appearance

it is caused by haemophilus inluenzae (should be rare now because of vaccination)

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7
Q

what is epiglottitis

A

cellulitis of the supraglotis

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8
Q

how should you manage epiglottitis

A

DO NOT EXAMINE THE THROAT

secure the airway and start IV Abx

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9
Q

what investigation is first line if you suspect inhaled foreign body

A

CXR

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10
Q

What are the signs of respiratory distress in a child

A

Tracheal tug, indrawing of the intercostal and subcostal areas, nasal flaring,

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11
Q

What causes a systolic murmur in children

A

VSD
Pulmonary or aortic stenosis
fallots tetralogy (pulmonary stenosis)

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12
Q

What could cause a diastolic murmur in children

A

Mitral stenosis
Truncus arteriosus (one vessel from RV and LV)
Pulmonary or aortic regurgitation

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13
Q

What are the signs and symptoms of heart failure in children?

A 
SOB
increasing RR
Dyspnoea
Poor feeding 
Struggle to gain weight or losing weight
Increasing heart rate
Poor pulses 
Hepatomegaly
Acidosis
Sweating
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14
Q

How would you manage cardiac failure in a child?

A
  1. diuretics (furosemide, amiloride)
  2. Short acting ace inhibitors (captopril ans enalopril)
  3. Oxygen
  4. prostins (for duct to be kept open)
  5. Diet/ fluid intake (they need their calories)
  6. Inotropes (dopamine , dobutamine, to boost cardiac output)
  7. Catheter intervention or surgery may be necessary
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15
Q

What kind of murmur is a VSD / Asd

A

Pan systolic

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16
Q

What kind of murmur is a pulmonary stenosis murmur

A

Ejection systolic

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17
Q

Signs of cyanotic heart disease in a child?

A

Central cyanosis
Pulmonary oligaemia on CXR
May have a murmur

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18
Q

Name a cyanotic CHD

A

Tetralogy of fallot
Transposition of great arteries
AVSD

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19
Q

What are the features of tetralogy of fallot

A

VSD
Aorta dextroposition
Pulmonary stenosis
RV hypertrophy

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20
Q

Acyanotic heart disease

A 
VSD/Asd
Coarctation aorta
Aortic and pulmonary stenosis
PDA
Mitral and tricuspid stenosis
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21
Q

What isa PDA

A

Normal part of fetal circulation between aorta and pulmonary artery is still open
Causes oxygenated blood to mix with non oxy blood
Can put strain on the heart

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22
Q

Cough and breathless child differentials

A 
Asthma
LRTI
Cardiac failure
Upper airway obstruction (incl foreign body)
Pneumothorax
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23
Q

Signs of upper airway obstruction

A 
Drooling
Stridor
Hoarse voice
Respiratory distress
Recession and tracheal tug
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24
Q

Signs of chronic chest disease

A

Clubbing
Harrison’s sulcus
Recurrent cough and chest infections

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25
Q

Management of asthma in kids?

A

SABA!
SABA + ICS
SABA + ICS + leukotriene receptor antagonist

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26
Q

Signs of life threatening asthma

A

o2 sats less than 92
Cyanosis
Feeble resp effort
Hypotension

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27
Q

What are the two types of wheeze in pre school children

A

Episodic viral wheeze

Multiple trigger wheeze

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28
Q

Management of cystic fibrosis

A 
Regular chest physio / postural drainage
High calorie diet incl high fat intake
Vitamin supplement 
Pancreatic enzyme supplement
Eventually heart and lung transplantation.
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29
Q

How are ppl diagnosed w cf

A

Via bloodspot screening test as a newborn

Can do sweat test

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30
Q

What is acute Resp distress syndrome

A

Non cardio genie pulmonary oedema and diffuse lung inflammation syndrome

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31
Q

Causes of ARDS

A

Pneumonia
Sepsis
Aspiration
Severe trauma

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32
Q

Kawasaki disease features

A 
CRASH and BURN
C= conjunctival injection and cervical lymphadenopathy
R= rash 
A=Arthralgia
S=Strawberry Tongue
H= Hands and skin peeling
and BURN = high grade fever >5 days
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33
Q

How do you treat Kawasaki?

A

High dose aspirin

They also need echo - they are at risk of coronary artery aneurysm

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34
Q

what is volvuius?

A

when a part of intestine wraps around itself and its mesentery and causes bowel obstruction

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35
Q

what is Meckels Diverticulum?

A

an embryological remnant. may be asymptomatic but may also lead to profuse rectal bleeding, volvulus and intussusception

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36
Q

what does billious vomiting in first 1-3 days of life suggest?

A

intestinal obstruction
causes
intestinal malrotation
volvulus

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37
Q

abdo pain red flags

A 
delayed growth/ weight loss
bloody stools
under age 5
oral ulcers
billious or blood vomit
fever
dysphagia
NSAID use
fhx IDB/coeliac/PID
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38
Q

how would coelic present

A

weight loss
gluteal muscle wasting
loose stools

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39
Q

when to start weaning

A

4-6 months

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40
Q

what are some causes of weight loss in children?

A 
IBD
Coeliac
Anorexia
DIabetes
Addisons
Malignancy
Juvenile Arthritis
Hyperthyroid
Achalasia
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41
Q

what are the risks of rapid weight loss?

A

refeeding syndrome
cardiac arrythmias
infection
hypoglycaemia

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42
Q

how would you treat life threatening anorexia

A

admit for fluids (10% dextrose and 0.45% saline) and thiamine and vitamin B complex
regular obs
monitor bloods - esp Phosphate (refeeding)
monitor ecg (refeeding and cardiac arrythmias)
BMs
contact local eating disorder team
diet plan

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43
Q

how do you manage anorexia?

A
  • Anorexia focused family therapy

CBT

44
Q

what are the clinical signs of dehydration?

A 
dry mucous membranes
prolonged cap refill
weak thready pulse
hypotension
tachycardia
reduced urine output 
thirst 
reduced skin turgor
lethargy
dyspnoea
sunken eyes
mottled cool limbs
shock
altered consciousness
45
Q

most common causes of viral gastroenteritis in children

A
  • rota virus
  • norovirus
  • adenovirus
46
Q

most common causes of bacterial gastroenteritis

A

campylobacter

e coli

47
Q

features of intussusception

A

peak presentation 3 mo - 2 yrs
legs drawn up (colicky pain)
pallor during episodes
red currant jelly stool

48
Q

Haemolytic Uraemic Syndrome is a triad of …

A

thrombocytopenia
renal failure
haemolytic anaemia

49
Q

how do kids get HUS

A

typically following gastroenteritis from E coli.

50
Q

how do you treat HUS?

A
  • fluids
  • dialysis
  • plasmapheresis
51
Q

what does vomiting with paroxysmal cough represent?

A

whooping cough

52
Q

what can cause febrile illness in kids

A
  • Infections (UTI, GI, LRTI/URTI, ENT, Joints, rashes, CNS, )
  • Kawasaki
  • Autoimmune eg SLE, JIA
  • Malignancy
53
Q

how would you manage HSP

A

-Analgesia
Supportive care
monitor urine for progression to nephrotic/nephritic syndrome
if renal problems then corticosteroids

54
Q

features of measles

A

starts as general malaise and coryzal symptoms
progresses to kolpik spots inside the mouth, and rash on face and behind ears
rash then spreads to the trunk and limbs
palms and soles are often spared
high fever is present
cough may be present too
rash is non painful and non itchy

55
Q

Symptoms of ADHD?

A

Inattention
Hyperactivity
Impulsivity
Impaired functioning (in more than one domain )

56
Q

sits w/o support straight back?

A

7-8 months

57
Q

runs?

A

16months-2years

58
Q

rides a tricycle

A

3 years

59
Q

palmar grasp

A

6 months

60
Q

draws a circle

A

3 years

61
Q

tower of 3-4 blocks

A

18 months

62
Q

starts playing alongside, but not interacting with other children

A

2 years

63
Q

pulls to standing

A

8-10 months

64
Q

hops on one leg

A

3-4 years

65
Q

squats to pick up a ball

A

18 months

66
Q

responds to own name

A

9-12 months

67
Q

talks in short sentences

A

aged 2.5- 3 years

68
Q

little or no head lag

A

3 months

69
Q

walks

A

15 months`

70
Q

crawls

A

8-10 months

71
Q

what is hirsprungs disease?

A

absence of ganglion cells. Red flag is delayed passage of meconium (>48 hours) and ribbon like stools and weight loss

72
Q

choice of imaging in intussuption

A

USS

73
Q

at what age should children achieve day and night time continence?

A

3- 4 years

74
Q

what are the features of autism

A
  • global language and communication impairment
  • ritualistic and compulsive behaviour
  • impairment of social relationships
75
Q

Developmental delay ddx

A
  • non specific developmental delay
  • cerebral palsy
  • muscular dystrophy
  • undiagnosed condition
  • delayed motor maturation
76
Q

what is the most common cause of viral meningitis?

A

enteroviruses eg cocksackie and echovirus

77
Q

what are the commonest causes of meningitis in neonates

A
  • group b strep
  • e coli
  • listeria
78
Q

what are the commonest causes of meningitis > 3 months

A

N. meningitidis
Pneumococcous
Hib

79
Q

what are commonest cause of meningitis >6 yrs

A

meningococcus

pneumococcus

80
Q

what may cause nephrotic syndrome in children?

A
  • Minimal change disease
  • HSP
  • SLE
81
Q

what are the features of nephrotic syndrome?

A
  • proteinuria
  • oedema
  • hypoalbuminaemia
82
Q

complications of nephrotic syndrome?

A

think loss of protein

  • thrombosis
  • infections
  • peritonitis
83
Q

how do you treat minimal change disease?

A
  • steroids
  • prophylactic antibiotics
  • for frequent relapses cytotoxics eg cyclosporin
84
Q

how can you manage nocturnal eneuresis

A

exclude DM and UTI

  • psychosocial training , behaviour training and rewards
  • 1st line = alarm training
  • 2nd line desmopressin
85
Q

how would you manage AKI in children?

A
  • ABCDE
  • Monitor PEWS, fluid status, urine output, creatinine
  • maintain circulation
  • minimise further harm
86
Q

what are risk factors for UTI and serious underlying pathology in kids?

A
  • fhx vesicoureteric reflux
  • high BP
  • antenatal hydronephrosis
  • poor urine flow
87
Q

features of aplastic anaemia

A
  • anaemia
  • thrombocytopenia
  • leucopenia
88
Q

clinical signs of leukaemia

A
  • anaemia/fatigue
  • bruising bleeding and infections
  • spleno and hepato megaly
  • testicular swelling
  • bone pain
  • fever
89
Q

how to treat lyme disease?

A
  • doxycycline >12 yrs

- amoxicillin <12 yrs

90
Q

`risk factors for epilepsy

A
  • neuro disease eg cerebral palsy, tuberous sclerosis. mitochondrial disease
  • fhx epilsepsy
91
Q

features of a febrile seizure

A

following high fever
brief tonic clonic
age 3 month-5 yrs

92
Q

first line drug for generalised seizures?

A
  • sodium valproate
93
Q

first line drug for focal seizures

A

carbamazepine or lamotrigine

94
Q

tmt of meningtis in the community?

A

IM Benzylpenicillin

95
Q

what can cause global developmental delay

A

cerebral palsy

96
Q

features of cerebral palsy

A

abnormal limb/trunk movements
delayed milestones
poor feeding/oromotor coordination
assymetric hand function`

97
Q

what to do if u suspect cerebral palsy

A

mri

98
Q

how to manage cerebral palsy?

A 
occupational therapy
physiotherapy
speech therapy
adaptive environment orthoses
injections botox ,baclofen, surgery
counsel
99
Q

neonatal jaundice

A 
in first 24 hours is ALWAYS PATHOLOGICAL 
causes:
-rhesus haemolytic disease
-ABO haemolytic disease
-Heredirtary spherocytosis
_GP6D deficiency

JAUNDICE IN NEONATE FROM DAY 2 - 14 IS USUALLY PHYSIOLOGICAL (Breast milk jaundice)
as long as they’re feeding properly and monitoring the bilirubin then it is fine

CAUSES OF PROLONGED JAUNDICE

  • biliary atresia (bile ducts blocked/absent)
  • hypothyroidism
  • UTI
  • galactocaemia
  • congenital infections (CMV toxoplasmosis)
100
Q

what are the red flags for development

A 
smiling 2/12
good eye contact 3/12
sitting 9/12
walking 18/12
2-3 word sentence construction 2.5years
101
Q

common developmental assessment stations

A

late walker >18 months
visual or hearing impairment
developmental disorder autism
emotional disorder eneuresis (>5y) , elective mutism, sleep disorder
behavioural disorder eg conduct disorder , ADHD
gross developmental delay eg from mental retardation , genetic abnormality, brain injury, congenital infection,endocrine disorder.

102
Q

red flags when spotting a seriously ill child?

A
  • mottled/ashen/pale skin
  • RR >60
  • grunting
  • no response to social cues
  • reduced skin turgor
  • does not wake /if awoken does not stay awake
  • appears ill to a health care professional
  • focal neuro signs
  • status epilepticus
  • <3 months old
  • fever > 38
  • non blanching rash
  • bulging fontanelle
  • neck stiffness
  • chest indrawing
  • continuous high pitched cry
103
Q

otitis media examination findings?

A

bulging tympanic membrane

104
Q

symptoms of otitis media

A 
otalgia
irritability
decreased feeding
vomiting
fever
preceding URTI
sleep disturbance
105
Q

what is Kernigs sign?

A

flexion of the hip and knee and then pain once these are then extended

106
Q

what is Brudzinskis sign?

A

passive flexion of the neck results in felxion of the knees and hips

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