Paeds Common Flashcards
1
Q
- What is the most common cause of bronchiolitis ?
A
- RSV (75-80%) of cases
- Others PAIRR
- Parvovirus
- Adenovirus
- Infuenza
- Rhinovirus
2
Q
- When is peak incidence of bronchiolitis ?
A
- 3-6 months
3
Q
- What are common features of bronchiolitis ?
A
- Coryzal symptoms (mild fever) preceding
- Dry cough
- Increasing breathlessness
- Wheezing, fine inspiratory crackles (not always present)
- Feeding difficulties with increasing dyspnoea = often reason for hospital admission
4
Q
- Red flag (ambulance) symptoms in infants with bronchiolitis ?
A
- Apnoea
- Child looks seriously unwell to a healthcare professional
- Severe respiratory distress e.g. grunting, marked chest recession or RR over 70
- Central cyanosis
- Persistent oxygen saturation of less than 92% when breathing air
5
Q
- NICE ‘consider’ hospital referral for infant with bronchiolitis ?
A
- RR over 60
- Difficulty with breastfeeding or inadequate oral fluid intake
- Clinical dehydration
6
Q
- Investigation for bronchiolitis
A
- Immunofluorescence from nasopharyngeal secretions may show RSV
7
Q
- What is management of bronchiolitis ?
A
- Largely supportive
- Humidified oxygen is given via a head box if below 92%
- NG tube if not feeding
- Suction is sometimes used for excessive upper airway secretions
8
Q
- Concerning signs in a baby in respiratory distress
A
- Tracheal tug
- Head bobbing
- Cyanosis
- Noisy breathing
9
Q
- What would be seen on the BG of a baby with severe vomiting ?
A
- Hypochloraemia, hypokalaemic metabolic alkalosis
10
Q
- What is the cause of pyloric stenosis ?
A
- Hypertrophy of the circular muscles of the pylorus
11
Q
- What are RFs for pyloric stenosis ?
A
- Male (x4 MC)
- Fhx
- 1st born
12
Q
- Features of pyloric stenosis ?
A
- ‘projectile’ vomiting typically 30 minutes after a feed
- Constipation and dehydration may also be present
- A palpable ‘olive shaped’ mass may be present in the upper abdomen
- Hypochloraemia, hypokalaemic alkalosis due to persistent vomiting
13
Q
- How is pyloric stenosis diagnosed ?
A
- US
14
Q
- What is management of pyloric stenosis ?
A
- Ramstedt pyloromyotomy
15
Q
- When do febrile convulsions typically occur ?
A
- Between 6 months and 5 years
16
Q
- What are clinical features of febrile convulsions ?
A
- Usually occur early in a viral infection as the temperature rises rapidly
- Seizures are usually brief and last less than 5 minutes
- Commonly tonic-clinic
17
Q
- What are features of a simple febrile seizure ?
A
- < 15 minutes
- Generalised
- Should be complete recovery within an hour
18
Q
- What are features of a complex febrile seizure ?
A
- 15-30 minutes
- Focal seizure
- May repeat seizure within 24 hours
19
Q
- What are RFs that febrile seizures develop into epilepsy ?
A
- FHx
- Complex FC (30min)
- Background of neurodevelopmental disorder
20
Q
- Features of juvenile idiopathic arthritis
A
- pyrexia
- salmon-pink rash
- lymphadenopathy
- arthritis
- uveitis
- anorexia and weight loss
21
Q
- What anti-body may be positive in JIA ?
A
- ANA may be positive
- RF is usually negative
22
Q
- What are diagnostic criteria for JIA ?
A
- NO cause
- Lasting for more than 6 weeks
- Child under 16
- Joint pain, swelling and stiffness
- Can be multiple joints
23
Q
- What would be raised on bloods for JIA ?
A
- ESR
- CRP
- Platelets
24
Q
- What is management for JIA ?
A
- Naproxen and PPI
- 2nd line steroid injections
- 3rd line methotrexate (with folic acid)
- 4th infliximab
25
Q
- How is bacterial meningitis managed ?
A
- IV cefotaxime and amoxicillin
26
Q
- How is bacterial meningitis managed in neonates ?
A
- IV benpen and gentamicin
27
Q
- Signs of a severe asthma attack in children ?
A
- Sp02 < 92%
- PEF 33-50%
- Too breathless to talk or feed
- HR >125 (>5yo) or >140 (1-5yo)
- RR >30 (>5yo) or >40 (1-5yo)
- Use of accessory neck muscles
28
Q
- Signs of a life threatening asthma attack in children ?
A
- Sp02 < 92%
- PEF < 33%
- Silent chest
- Poor resp effort
- Agitation
- Altered GCS
- Cyanosis
29
Q
- How should a moderate to mild asthma exasperation be managed ?
A
- Salbutamol
- Steroid therapy 3-5 days
30
Q
- Triggers for asthma attacks
A
- Infections
- Smoking
- Exercise
- Cold weather
- Allergens
31
Q
- How is life threatening asthma managed ?
A
- Oxygen
- Neb salbutamol and ipratropium
- Oral steroids
- IV steroids
- IV magnesium sulphate
32
Q
- What are common features of anorexia nervosa
A
- Hypothermic, hypotensive and bradycardic
- Amenorrhea
- Lanugo hair
- Depression, anxiety and social isolation
33
Q
- What are complications of refeeding syndrome ?
A
- Arrhythmias
- Cardiac atrophy
- Sudden cardiac death
34
Q
- What is the basic pathophysiology of refeeding syndrome ?
A
- A rise in insulin with increased glucose drives phosphorus and K+ intracellularly causing a decrease in serum availability
- This can lead to weakness, fatigue and metabolic alkalosis
35
Q
- What heart condition is associated with Turners ?
A
- Coarctation of the aorta
- Systolic murmur below the left clavicle but loudest on the left scapula
- Bi-cuspid aortic valve (adults 82%)
36
Q
- What are features of Down’s ?
A
- Upslanting palpebral fissure
- Small low set ears and round/flat face
- Flat occiput
- Single palmar crease
- Hypotonia
- Congenital heart defects
- Duodenal atresia
- Hirschsprung’s disease
37
Q
- What is the most common cause of acute epiglottitis ?
A
- Haemophilus influenzae B
38
Q
- What are the features of acute epiglottitis ?
A
- Rapid onset
- High temp and generally unwell
- Stridor
- Drooling saliva
- Tripod position
39
Q
- What might be seen in acute epiglottitis on x-ray ?
A
- Lateral view = thumb sign
- PA view = steeple sign
40
Q
- What is the management of acute epiglottitis ?
A
- Immediate senior involvement e.g. anesthetics and ENT
- Oxygen
- IV ceftriaxone
- IV dexamethasone
41
Q
- What should be done to investigate a non-accidental injury ?
A
- CT head
- Skeletal survey
- Clotting profile
