Paeds Flashcards
Mid-parental height
Girls:Mother+(father-13)/2 –> girls have to shorter than father
Boys: (Mother+13)+father/2
Biological mid parental height rang- +/- 7.5-8
Gastro- how long vomiting and how long diarrhea
Vomiting usually settles within a couple of days but diarrhoea can last up to 10 days.
Fluid bolus- Should we count that in our fluids equation
No you should not
Degree of dehydration (deficit) plus Maintenance fluid requirements plus Ongoing losses
Replacement of deficits- should be done fast in which kids and slow in which kids
Replacement may be rapid in most cases of gastroenteritis (best achieved by oral or nasogastric fluids), but should be slower in diabetic ketoacidosis and meningitis, and much slower in states of hypernatraemia (aim to rehydrate over 48 hours, the serum sodium should not fall by >1mmol/litre/hour).
What is the cause of neonatal respiratory distress syndrome
Lung surfactant deficiency disorder
is a lung disorder in infants that is caused by a deficiency of pulmonary surfactant.
Transient tachypnea of the newborn (wet lung disease)
- can be made better
- who gets it
- treatment
Reversible respiratory disorder
Most commonly occurs in full-term neonates delivered by cesarean section. These infants often have fluid-filled lungs.
supportive care (e.g., supplemental oxygen, neutral thermal environment, adequate nutrition)
DDX for neonatal distress
1) Neonatal respiratory distress syndrome(NRDS)
2) TTPN
3) Congenital diaphragmatic hernia
4) Pneumothorax
5) Meconium aspiration syndrome
6) Neonatal pneumonia
What is bronchopulmonary dysplasia
chronic lung disease primarily found in premature infants exposed to prolonged mechanical ventilation and oxygen therapy for neonatal RDS
What is the cut off for corticosteroid administration is a fetus
35 weeks
Surfactant production occurs early, at around 20 weeks’ gestation. However, its distribution throughout the lungs begins around weeks 28–32 and does not reach sufficient concentration until week 35. Thus, any infant born before term is vulnerable to surfactant deficiency.
Failure to thrive kid who started losing weight just after introducing into solid food would be
Celiac disease until proven otherwise
What are some gastrointestinal symptoms of celiac disease
Chronic or recurring diarrhea steatorrhea Flatulence, abdominal bloating, and pain Nausea/vomiting Lack of appetite Constipation (rarely)
What are some extraintestinal symptoms and associations with celiac disease
Malabsorption symptoms: fatigue, weight loss, vitamin deficiency, iron deficiency anemia, osteoporosis, hypocalcemia
In children: failure to thrive, growth failure, delayed puberty
Dermatologic associations: dermatitis herpetiformis
Neuropsychiatric symptoms: peripheral neuropathies (numbness, burning and tingling of the hands and feet) , headache, ataxia, depression, irritability
What are the screening test for celiacs and what other immunological tests should be done
Gold standard: IgA (anti‑)tissue transglutaminase antibody (tTG)
Quantitative IgA test: In the case of an IgA deficiency, patients are tested for IgG-based antibodies.
IgG deamidated gliadin peptide (DGP) indications: year less than 2 it is better
Anti-endomysial antibody (EMA)
What is the confirmatory and diagnostic test for celiac
Duodenal biopsy
State 3 characteristics of the duodenal biopsy in a patient with celiac disease
Villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytic infiltration
What are the
1) screening test
2) diagnostic test
3) Follow up
Other blood: Folate, iron. Decreased with the involvement of duodenum
Screening-
IgA (anti‑)tissue transglutaminase antibody (tTG), IgG anti-deamidated gliadin antibody, also always do total IgA because of potentially associated IgA deficiency.
Diagnosis- Duodenal biopsy- showing intraepithelial lymphocytes and villis blunting/atrophy
Monitoring- Repeat anti-body testing, can take 12 months for Ab levels to normalise, intestinal healing can take up to two years, therefore, repeat duodenal biopsy should now be performed following at least 12 months of gluten-free diet
Celiac disease
-Acute management(follow up)-within 6 weeks
-Long-term management
1) Join celiac organization
2) Visiting a dieticians
3) Family screening
4) Bone density scan
5) Screening for other genetically associated conditions
After 6 months
1) repeat coeliac serology blood tests
after 12 months
1) repeat blood
2) Duodenal biopsy
Red Flags of failure of thrive(FTT)
1) Signs of abuse or neglect
2) Poor carer understanding e.g. non-English speaking, intellectual disability
3) Signs of family vulnerability e.g. drug and alcohol abuse, domestic violence, social isolation, no family support
4) Signs of poor attachment
5) Parental mental health issues
6) Already/previously case managed by child protection services
7) Did not attend or cancelled previous appointment/s
8) Signs of dehydration
9) Signs of malnutrition or significant illness
What are the 5 causes of poor growth
1) Inadequate caloric intake/retention
2) Psychosocial factors
3) Inadequate absorption
4) Excessive caloric utilization
5) Other Medical Causes
What are the inadequate absorption causes of FTT we should think about-3
Coeliac disease
1) Chronic liver disease
2) Pancreatic insufficiency eg. Cystic fibrosis
3) Chronic diarrhoea
4) Cow milk protein intolerance
correct for prematurity (<37 weeks) until how long
How do you do it
until 24 months of age
Down syndrome features
Face: round face, flat nasal bridge, up slanted palpebral fissures and protruding tongue
Flat occiput
Hand- single palmar(siamese crease), clindodactyl
Foot–> wide “sandal” gap between 1st and 2nd toe
Fetal alcohol syndrome diagnostic criteria
-what are the three sentinel features of the face
Prenatal alcohol exposure
Face: 3 sentinel features:
1) Smooth philtrum
2) Thin upper lip
3) Short palpebral fissure
Impairment in neurodevelopment: cognition, attention, memory and coordination
Predn dose for asthma
1mg/kg for asthma
Failure to thrive question for psychological issues
Has it ever been hard to take care of your child recent?
any financial problems? issues at home? your feel like not bonding with the baby as you use to?
Febrile seizures new guidelines for simple
<10 minutes is a simple febrile seizure
6 months-5 years
Burst therapy
3 doses in 1 hour
3 most sensitive parameters for dehydration-CRT
C-CRT
R-RR
T-tissue turgor
Fluid deficit equation that is the fluid loss for the whole day
Dehydration % x weight in kg x 10
Need to divide this by 24hr
How is trial of fluids in ED include
Aim for 10-20 mls/kg fluid over 1 hour of ORS
What fluid for bolus
maintenance
DKA
Bolus: 0.9% normal saline
Maintenace- 0.9% normal saline+ dextrose 5%
0.9% sodium chloride +/- potassium
The definite initial episode of ARF
2 major
OR
1 major and 2 minor manifestations
plus evidence of a preceding GAS infection
The definite recurrent episode of ARF in a patient with known
past ARF or RHD
2 major or
1 major and 1 minor or
3 minor manifestations
plus evidence of a preceding GAS infection
Major criteria in ARF in the high-risk group
1) Carditis (INCLUDING subclinical evidence of rheumatic valvulitis on echocardiogram)
2) Polyarthritis†† or aseptic mono-arthritis or polyarthralgia
3) Chorea
4) Erythema marginatum¶
5 )Subcutaneous nodules
Minor criteria in ARF in the high-risk group
1) Monoarthralgia
2) Fever‡‡
3) ESR ≥30 mm/h or CRP ≥30 mg/L
4) Prolonged P-R interval on ECG§§
Major criteria in ARF in all other groups
1) Carditis (EXCLUIDNG subclinical evidence of rheumatic valvulitis on echocardiogram)
2) Polyarthritis††
3) Chorea
4) Erythema marginatum
5) Subcutaneous nodule
Minor criteria in ARF in all other groups
Fever
Polyarthralgia or aseptic monoarthritis
ESR ≥30 mm/h or CRP ≥30 mg/L
Prolonged P-R interval on ECG
Mnemic for ARF/RHD- JONES and CAFE PAL
Look at google image
Recommended antibiotic regimens for secondary prevention
BPG, benzathine penicillin G; im, intramuscular.
4 weekly, or 3 weekly for selected groups
Innocent Murmurs
Hallmarks: 7’s inoSSents
- Soft
- S1 and S2 Normal (Heart sounds normal)
- Symptomless
- Systolic
- Short
- Standing / sitting may vary (change with posture) 7. Special Tests Normal (ECG/CXR/ECHO normal)
…also commonly Left sternal edge ( no radiation)
Acyanotic murmurs
VSD > PDA > ASD
Most Common CHD
VSD
Continuous Machinery murmur
-treatment
PDA
- Indomethecin to close the PDA
- Prostaglandin E keeps PDA open (for TGA’s)
TOF- 4 features
CXR shows
Pulmonary stenosis (causing Large VSD),
Right ventricular hypertrophy (RVH). Overriding aorta.
VSD
Ejection systolic murmur – left the sternal edge
CXR – the boot-shaped heart. ECHO (increased right
ventricular size).
Down syndrome children are increased risk of-3
Increased risk of: – Duodenal Atresia – Squint – Hypothyroidism – Leukaemia – Hirschprung’s disease – Deafness
Kawasaki disease affects which vessel
Small and medium
Causes of stridor
- Croup,
- Epiglottitis,
- Anaphylaxis,
- Laryngomalacia,
- Foreign body inhalation
- Bacterial tracheitis,
- Smoke inhalation
- Obstructive Malignancy.
4D of epiglottitis
-treatment
Dysphagia
Dysphonia(hot potato voice)
Distress
Drooling
IV Antibiotics
Empiric therapy: third-generation cephalosporin
Outline the management of asthma
- in mild
- moderate
- severe
asthmatic patient
Look at Queensland children hospital guideline
Risk factors for severe asthma- what kind of questions would you ask
1) previous admissions to ICU
2) Past Hx of anaphylaxis
3) Multiple episodes
When can child roll over
3-6 months
What are the development facets we are looking at
Gross motor skills Fine motor skills Language skills Social development and cognition Vision and hearing
2 core features in the ASD criteria and give examples
Persistent impairment in communication and social interaction (inability to form relationships, abnormal language development, reduced empathy, difficulties in adjusting behaviour to social situations, and poor eye contact)
Restricted, stereotyped patterns of behaviour, interests, and activities (e.g., hand flapping, excessive touching/smelling, lining up toys, adverse response to sounds, and echolalia)
What kind of pointing do ASD kids have
Protoimperative pointing than protodeclerative pointing
What are conditions need to be ruled out with GERD
Chronic reflux due to diseases of neuro disorders such as Cerebral Palsy
Chronic lung disease of prematurity
Pyloric stenosis electrolyte distrubance
Hypokalaemic Hypochloraemic Metabolic alkalosis =low plamsa K+ due to vomit
What other condition can look like Gastro
DKA
Red flags of gastroenteritis
1) severe abdominal pain or abdominal signs
2) persistent diarrhoea (> 10 days)
3) blood in stool
4) very unwell appearance
5) bilious (green) vomit
6) vomiting without diarrhoea
DDx for child with a limp and give sentence
1) Transient synovitis
2) Perthe’s disease
3) SUFE
4) Septic arthritis
5) JIA
6) Fracture/Trauma
7) NAI
8) Osgood-Schlatter disease
9) DDH
DDX for non-epileptic seizures
1) Febrile convulsions
2) metabolic
3) head trauma–> could be a reflex anoxic seizure?
4) meningitis/ encephalitis
5) toxins/poisons–> did you see him ingesting something usual before this happened?
Reflex Anoxic seizures/Pallid breath holding
Non-epileptic, syncope due to sudden drop in cerebral perfusion due to shock eg. bump to head, falling over etc. May go pale. Rapid recovery.
Reflex Anoxic seizures/Pallid breath-holding
Non-epileptic, syncope due to sudden drop in cerebral perfusion due to shock eg. bump to head, falling over etc. May go pale. Rapid recovery.
5 important rashes you need to be aware of in paeds
1) Measles
2) Rubella
3) Mumps
4) Chickenpox
5) Erythema infectiousum/ fifth disease/slapped cheek syndrome
6) Scarlet fever
Cleft lip and palate- definition
- what maternal factors causes this?
- surgical repair
- what MDT is needed
- what sequence is associated and triad does it have
Failure of the fusion of frontonasal and maxillary processes
-mother taking ANTICONVULSANTS
6-12 month for the palate
1st week-3 month for lip
Most will need speech therapy
Pierre Robin sequence:
micrognathia, glossoptosis, and airway obstruction.
Neural tube defects
- tell the three types
- tell me features about each one
Look at that slide on the paeds review folder
Causes of obesity in children- what are the 4 categories you need to explore
Environmental
Hormonal
Genetic
Medications
Environmental
1) Excess energy intake
2) Decreased activity levels
Hormone problems
1) Under functioning thyroid
2) Problems with the production of growth hormone
3) High steroid levels
4) PCOS
5) Other hormonal problems
Medications
1) Behaviour-related medications (such as antidepressants
2) Medications for fits and seizures
3) Steroids
Genetic syndromes
1) Prader-Willi syndrome
2) Other genetic syndromes-turner syndrome
Intertrigo
OSA- due to fat- how is his sleep?
What are the baseline tests and other tests to consider in an obese child
Baseline:
1) Blood lipids
2) Liver function tests
3) FBC-> general health, anaemia, infections
Consider the following when clinically indicated
1) Blood sugar and insulin levels/OGTT
2) Hormone function, such as thyroid hormone levels
3) Vitamin and nutrient levels (such as Iron, vitamin D, Vitamin B12)
Causes of a child who has short stature but steady growth before centile
Constitutional(familial)short stature Maturational delay Turner's syndrome IUGR Skeletal dysplasia(Rare)--> achondroplasia
Causes of a child who is shortfall off in growth across centile(losing height)= so failure to thrive with losing height
Chronic illness- Crohn's disease and chronic renal insufficiency Acquired hypothyroidism Cushing's Growth deficiency Psychosocial
5210 RULE for obese children
5- at least 5 fruits or vegetables per day
2- no more than 2 hrs screen time per day(<2 years old no screen time)
1- 1hour physical activity
0-No sweetened drinks
Overweight percentiles
85th to 95th
Obese percentiles
> 95th
BMI calculation
Kg/m2
In a simple febrile seizure, once the seizure has terminated, the aim of the assessment is to
determine the cause of the fever
In an afebrile seizures(seizure) what should be looked at in the past medical history
Past history – previous seizures and anti-seizure medication (management plan if in place), neurological comorbidity (e.g. VP shunt, structural brain abnormality) renal failure (hypertensive encephalopathy), endocrinopathy (electrolyte disturbance)
evidence of underlying cause that may require additional specific emergency management. Underlying causes include: hypoglycaemia electrolyte disturbances meningitis drug/toxin overdose trauma stroke and intracranial haemorrhage
In seizure child, what other system history is very important(besides neuro)
CARDIO
Ask about:
aura, focal features level of awareness recent trauma, consider non-accidental injury focality of limb or eye movement post-ictal phase/hemiparesis Relevant past history
Family history of seizures or cardiac disorders/sudden death
History suggestive of absence seizures or myoclonic jerks, nocturnal events
Developmental history
DDx for seizure-4 as given for RCH
1) Arrhythmia
2) Breath-holding spell (episode occurs when the child is crying)
3) Vasovagal syncope with anoxic seizure (postural change, preceded by dizziness and nausea)
4) Non-epileptic paroxysmal disorder
Also on examination look for
Full neurological examination looking for any abnormal neurological findings, signs of meningitis or raised intracranial pressure
Cardiovascular examination including BP and look for any signs that suggest an underlying cause e.g. neurocutaneous stigmata, microcephaly
Red for a seizure child
- Head injury with delayed seizure
- Developmental delay or regression
- Headache prior to the seizure
- Bleeding disorder, anticoagulation therapy
- Drug/alcohol use
- Focal signs
Pre-term baby: corrected age formula
Corrected age = Actual age - number of weeks premature
It is recommended to correct age for prematurity for children born before 37 weeks until the age of 2 years
When plotting the growth chart what is the age you use- corrected or actual
Corrected
What areas are you looking for in a febrile child
Colour Activity Respiratory Circulation and hydration Neurological Others
Febrile child- Infants ≤ 28 days corrected age- 3 steps you must do
Should be assessed promptly and discussed with a senior doctor
FBE, CRP, blood culture, urine (SPA), LP ± CXR
Admit for empiric antibiotic
Which type of febrile child should not undergo a LP
LP should not be performed in a child with the impaired conscious state, focal neurological signs impaired coagulation or haemodynamic instability (see Lumbar puncture). In this circumstance, treatment for meningitis/encephalitis can be commenced and an LP can be performed when the patient is stable and there are no other contraindications present.
Septic children may present with cold shock features
-which children get it
cold shock characterised by a narrow pulse pressure and prolonged capillary refill. The underlying haemodynamic abnormality is septic myocardial dysfunction, which is more common in infants and neonates.
Septic children may present with warm shock features
-which children get it
warm shock characterised by a wide pulse pressure and rapid capillary refill. The underlying haemodynamic abnormality is vasoplegia, which is more common in older children and adolescents.
