Paeds Flashcards
5yr old boy, non-blanching rash on shins for few days. “palpable purpura”. Nasty cold few weeks ago. Current diarrhoea and abdo pain. Pain in ankles. DDx?
HSP
ITP
SLE
Meningococcal Septicaemia
5yr old boy, non-blanching rash on shins for few days. Nasty cold few weeks ago. Current diarrhoea and abdo pain. Pain in ankles.Ix?
Abdo exam Urinalysis. FBC (raised platelets -> ITP) Creatinine -> Kidney involvement Adb USS Blood film
HSP management?
Supportive. Self resolve in 4/52 if no renal involvement.
NSAIDS for joint pain
Monitor kidney function.
watch ofr orchitis
What is the renal monitoring schedule supposed to be like for a patient suffering from HSP?
If no proteinuria: BP and urinalysis at days 7 and 14 and at 1, 3, 6, 12 months.
If proteinuria present: Follow-up at 7 and 14 days and monthly from 1-6 months then at 12 months.
What is the most common cause of HSP?
Group A strep
What is the vaccination schedule over the 1st 6 months ?
2,3,4 months. DTP (diphtheria, tetanus, pertussis) Polio, HiB, Men C (3+4) Pneumococcial (2+4)
Which vaccines are given at 1 yr?
HiB (hamophilus influenza) MenC
At what age in s the MMR given and what is given alongside it?
13 months (with Pneumococcal) Booster at 3yrs and 4 months
What are do Koplik spots look like and what do they indicate?
Grains of salt on red background in the mouth
MEASLES
What Ab’s do you give in meningococcal septicaemia?
< 3 months: IV amoxicillin + IV cefotaxime
> 3 months: IV cefotaxime
Sunayna is 1 year old and presents with abdominal pain and vomiting. You have been asked to write up full maintenance fluids for her. She weighs 12kg
Which fluid regime would be most appropriate?
1100ml of NaCl 0.9% plus 5% dextrose over 24 hours
Maintenance:
100mls/kg/day for each of first 10kg (ie 0-10kg)
50ml/kg/day for each of next 10kg (ie 10-20kg)
20ml/kg/day for every further kg
Maria is 4 years old and weighs 17kg. She presents with a non-blanching rash and a fever of 39 degrees
Her heart rate is 180 and her blood pressure is 64/40
What is the most appropriate initial fluid management?
340ml 0.9% NaCl bolus
Bolus fluids:
20ml/kg 0.9% NaCl in most situations
10ml/kg when……
DKA, Trauma, Fluid overload or heart failure
Marco presents following 2 days of profuse diarrhoea and vomiting. He has dry lips and is tachycardic, but is not shocked. He is not tolerating any oral intake. You estimate that he is 3% dehydrated. He weighs 10kg.
What would be the most appropriate fluid regimen to correct his dehydration?
1300ml 0.9% NaCl + 5% dextrose over 24 h
ie. Maintenance fluids PLUS %dehydration
Most of your body is water -> estimate the % lost
Weigh the child if possible.
1kg weight loss = 1000ml lost
Estimate clinically if not possible
3% weight loss in 10kg child.
10kg = 10000g = 10000mls fluid
1% = 100ml, therefore 3% = 300ml
ADD the correction onto maintenance fluids over 24h
Abdul is 6 years old and presents with 24 hours of cough and difficulty in breathing. He is found to be wheezy and is given 3x nebulised salbutamol, 2x ipratropium bromide and oral prednisolone.
30 minutes later he is still wheezy and shows signs of respiratory distress. He appears to be shivering and has vomited twice.
What is the most appropriate next management step?
Magnesium Sulfate bolus IV
What are the make up for APGAR
A Appearance ! colour P Pulse ! heart rate G Grimace ! irritability A Activity ! muscle tone R Respiration ! respiratory function
