Paeds: crib list Flashcards
Respiratory distress
Vitals - RR, SpO2 (likely if on oxygen), HR
Inspection (and A-E) - recessions, nasal flaring, cyanosis, tiring, drowsiness,
Auscultation - grunting, silent chest, crackles, (stridor, wheeze)
Reflexes
a) Primitive (MRS BAPS) - up to ~ 6 months
b) Postural (LLPP)
a) Moro, rooting, sucking, Babinksi, ATNR, palmar grasp, stepping
b) Landau, Lateral propping, parachute, positive support
Causes of short stature
a) 4 categories
b) ABCDEFG
a) Reduced intake, malabsorption, increased requirement, dysregulation
b) Alone (neglect), Bone dysplasia, Chromosomal (Turner, Down), Endocrine (GH, T4), Familial (genetics, constitutional delay), Gastro (coeliac, IBD, CF)
Congenital hypothyroidism: features
a) Vitals
b) Appearance/signs on examination
c) Symptoms
a) Bradycardia, low temperature
b) Jaundice, hypotonia, large fontanelles, Myxoedema (coarse features), Macroglossia, Umbilical hernia, Goitre, SHORT STATURE
c) Feeding difficulties, Somnolence, Lethargy, Low frequency of crying, Constipation, cretinism
Puberty:
a) Girls - normal, precocious, delayed
b) Boys - normal, precocious, delayed
c) Causes of precocious
d) Causes of delay
a) Normal (8-13)
- Precocious (<8)
- Delayed (>13 without breast development or >15 amenorrhoea with normal breasts)
b) Normal (9-14)
- Precocious (<9)
- Delayed (>14 without testicular development)
c) Usually idiopathic (in girls), CAH
d) CDGP, chronic disease, gonadal dysgenesis
Neonatal jaundice:
a) What 3 groups to screen (timing, duration)
b) Screening tests (BLITH)
a) Onset <24h, onset >2 weeks, duration > 10 days
b) Bilirubin (serum if <24h, transcutaneous otherwise)
Liver function tests
Infection screen (TORCH, surface swabs, septic screen)
Thyroid function test
Haemolytic tests (FBC, Blood group and Rh, Reticulocyte count., Coombs, blood film, Hb electrophoresis and red cell enzyme essays for G6PD deficiency, pyruvate kinase deficiency)
Imaging USS if required
Heart murmurs:
a) Innocent characteristics
b) VSD - characteristics, other features, Ix
c) VSD investigations
d) VSD management
a) Soft, Systolic, Short, Symptomless (no WOB, no HF, no cyanosis, normal femorals), Small (no radiation), Single (no associated sounds), Sensitive (varies with posture)
b) Harsh pansystolic, LLSB, signs of heart failure
c) Investigate using CXR, ECG, Echo (diagnostic).
d) Treat with high energy feeds, diuretics, ACE +/-digoxin
Cyanotic CHD
- 1, 2, 3, 4, 5
- Caused by…?
1 - Persitent truncus arteriosus 2 - TGA 3 - Tricuspid atresia 4 - ToF 5 - TAPVR (oxygenated blood returns into R atrium, rather than L atrium)
Caused by mixing of ox/deox blood (right to left shunts) causing deox blood to be pumped to the body
Duct-dependent lesions:
a) Explain the 2 basic types
b) Presentation
c) DDx: cardiac and non-cardiac
d) How to differentiate cardiac vs pulmonary causes
e) Ix
f) Rx
a) - Duct-dependent systemic lesions: systemic circulation dependent on R-L flow through patent DA
- Duct-dependent pulmonary lesions: pulmonary blood flow is dependent on L-R shunting from the aorta to the pulmonary arteries through the patent DA
(DA closure in both cases can be catastrophic)
b) Difficulty feeding, SOB, Cyanosis, Acute cardiorespiratory collapse with shock (weak femorals).
c) Cardiac.
- Duct-dependent systemic circulation: critical AS, hypoplastic left heart, CoA
- Duct-dependent pulmonary circulation: pulmonary atresia, Critical pulmonary stenosis, TGA, Tricuspid atresia, ToF
Non Cardiac. - Persistent Pulmonary Hypertension of the Newborn (PPHN) - Primary pulmonary disease (Lobe collapse, pneumothorax, IRDS, etc.) - Sepsis, Metabolic disorders
d) Hyperoxic test (if improved oxygenation: respiratory)
e) CXR, ECG, Echo
f) - ABDCE (airway, oxygen and breathing support, monitor pre+post-ductal sats, fluid resuscitation if needed, dopamine if needed, monitor BP in all 4 limbs)
- PGE2 to keeps duct open - give before oxygen as oxygen is a systemic vasoconstrictor
Classifying babies with suspected CHD
a) Blue, femoral pulses present, murmur - 4 DDs
b) Blue, femoral pulses present, NO murmur - 3 DDs
c) Blue/pink, femoral pulses ABSENT
d) Pink, femorals present
a) Cyanotic CHD: ToF, AVSD, TA
b) - Cyanotic CHD: TGA, TAPVR
- Persistent pulmonary HTN
c) Duct-dependent systemic lesions: CoA, critical AS, hypoplastic left heart, interrupted arch
d) VSD, ASD, AS
Persistent pulmonary hypertension of the newborn
a) Pathophys
b) Causes
c) Presentation
d) Ix
e) Rx
a) Normally - first breath leads to pulmonary vasodilatation and reduction in pulmonary blood pressure.
- In PPHN, this doesn’t happen, causing persisting pulmonary hypertension
b) Meconium aspiration, infection, diaphragmatic hernia
c) Blue baby, normal femorals, hypoxic, respiratory distress, poor feeding
d) CXR, ECG, Echo, pre+post-ductal sats
e) ABC (oxygen and ventilation, feeding support, fluids and antibiotics, dopamine if necessary),
- Nitric oxide (NO) may be useful as a vasodilator
Asthma vs. viral wheeze
DR BANT
Dry cough Recurrent/persistent Bronchodilator response Atopy Nocturnal symptoms Triggers
Asthma/wheeze management
a) Indications for step-up asthma management (3)
b) Management of exacerbation: O SHIT ME
c) Step-wise (< 5 years)
d) Step-wise (> 5 years) - differences
a) Salbutamol (>2/week), sleep disturbance (1/week), Exacerbation in previous 2 years requiring admission
b) Oxygen, Salbutamol, Hydrocortisone (or pred), Ipratroprium, Theophylline, Magnesium, Escalate
c) Conservative (triggers, diet, exercise, educate, monitor, review, asthma action plan), Step 1 (B2 agonist), Step 2 (Preventer ICS or LTRA), Step 3 (ICS and LTRA), Step 4 (referral to paeds, note: refer under 2s at step 3)
d) Step 3: add LABA, or increase ICS. If still not controlled, add LTRA or theophylline
Step 4: increase ICS again. Step 5 (requiring regular oral steroids): refer to paeds)
Fluids and resus and traffic light system
Covered in separate deck
Collapsed child
WET FLAG
Weight: (age + 4) x 2 Energy: (age/4) + 4 Tube (NG) Fluids - 20ml/kg (or 10 - neonates, DKA, trauma) Lorazepam Adrenaline/dopamine (and escalate) Glucose
Development
a) By age 6m
b) By 1 year
c) By 18m
d) By 2 years
e) By 3 years
f) By 4 years
g) By 5 years
a) Sit without support, roll onto back, palmar grasp, reach for toys, babbling, put food in mouth
b) First steps, pincer grip, transfer objects, scribble, one word sentences, drink from a cup
c) Walking confidently, tower of 2 cubes
d) Walk up two steps, tower of 6 cubes, draw line, 2-word sentences, cooperates with dressing
e) Jump, tower of 8 cubes, draw circle, speech mostly understandable, names a friend
f) Hop and skip, draw square, knows colours, dress without help, toileting
g) Ride bike, knows meaning of words
Developmental red flags
Gross Motor
- Not sitting by 1 year
- Not walking at 18 months
Fine Motor
- Hand preference before 18 months
Speech and language
- Not smiling by 3 months
- No clear words by 18 months
Social development
- No response to carers interactions by 8 weeks
- Not interested in playing with peers by 3 years
THE MISFITS
- the main 4
Trauma Heart Endocrine Metabolic Inborn errors Seizures/neuro Formula Intestinal Toxins Sepsis
Main 4:
- Sepsis
- CHD
- NAI
- Metabolic
Septic screen
a) Under 1 month
b) 1 - 3 months
c) Over 3 months - green, amber, red
a) FUCC LP (FBC, Urine, CRP, Culture, LP)
b) FUCC (only add LP if unwell/raised WCC)
c) - Green (urine)
- Amber (FUCC, + LP if under 1 year, + CXR if fever and raised WCC)
- Red (FUCC + LP + Gas + CXR depending on clinical picture)
Immunisation schedule
a) Four at 8, 12 and 16 weeks (largely the same)
b) Four at 1 year
c) Two at 3 years (pre-school)
d) Seasonal for 2 - 8 year olds
e) 3 for teenage girls (2 for teenage boys)
f) Optional/at-risk groups
a) 6-in-1 (Dip, polio, tetanus, pertussis, Hib, Hep B),
PCV, Rotavirus, Men B
b) MMR, PCV, Men B, Hib/Men C
c) MMR booster, 4-in-1 pre-school booster (DTaPP)
d) Nasal flu vaccine
e) HPV, 3-in-1 teenage booster (DTaP), Men ACWY
f) Flu, BCG, Chickenpox, Hep B
Paediatric sepsis 6
a) Suspect in patients with 2 or more of what 4 features? (PATT)
b) Lower threshold in what groups?
c) 6 actions
a) Poor peripheral perfusion/increased CRT, Altered mental state, Tachycardia, Temperature <36/ >38.5C
b) < 3 months, recent surgery, ID
c) - Administer high-flow oxygen
- IV/IO access and do septic screen (FUCC, blood gas and lactate)
- Administer IV/IO antibiotics
- Consider fluid resuscitation (20ml/kg)
- Involve senior support
- Give 2nd and 3rd fluid bolus then inotropes
- HDU/ICU (invasive monitoring, dialysis, mechanical ventilation, etc.)
Kawasaki
- Fever for 5 days + at least 4 out of…HEART
- other features
H - Hands and feet erythema, oedema and desquamation
E - eye (bilateral conjunctival injection without exudate)
A - adenopathy (15mm cervical, usually unilateral)
R - rash polymorphic
T - tongue strawberry and chapped lips
Coronary artery aneurysms - do an ECHO
Increased ESR and platelet count
Treat with aspirin and IVIG
UTI in children
a) Atypical
b) Recurrent
c) Urine dip vs MSU
a) Seriously unwell/septic, reduced urine output, abdominal mass, non-e.coli, raised serum creatinine, poor response to ABx in 48 hours
b) 2 or more Upper UTIs. 3 or more lower UTIs
c) < 3 months (MSU only)
- 3m - 3y (Dip: treat if leukocyte or nitrite positive, send for culture)
- >3y (Dip: treat only if nitrite positive, send for culture if leukocyte positive)
UTI imaging in children
a) MCUG - only needed in…?
b) USS during infection
c) USS within 6 weeks (1 group only)
d) DMSA
a) < 6 months if atypical/recurrent UTI or abnormality on USS in normal UTI
b) Atypical at any age, recurrent < 6 months
c) Normal UTI in < 6 months
d) Recurrent UTI at any age, atypical UTI < 3 years
