paeds general Flashcards
septic screen in kids
F Urine output Culture bloods Culture urine LP
child with sepsis - how would you recognise it..?
Recognition of a child at risk:
If a child with suspected or proven infection AND has at least 2 of the following:
• Core temperature < 36°C or > 38.5°C
• Inappropriate tachycardia (Refer to local criteria / APLS Guidance)
• Altered mental state (including: sleepiness / irritability / lethargy / floppiness)
• Reduced peripheral perfusion / prolonged capillary refill
define JIA
Joint inflammation
Idiopathic (not caused -
Age under 16
what are the criteria for kawasakis
four of: Conjunctivitis Rash Adeopathy Strawberry tongue hands and BURN - fever for 5 days or more
management of heart disease in kids
high energy regular feeds
Furosemide
ACEi
Digoxin
causes of failure to thrive in children:
Inadequate caloric intake/retention
Inadequate nutrition (breastmilk, formula and/or food)
Breast feeding difficulties
Restricted diet (e.g. low fat, vegan)
Structural causes of poor feeding eg. cleft palate
Persistent vomiting
Anorexia of chronic disease
Error in infant formula dilution
Early (before 4 months) or delayed introduction of solids
Psychosocial:
Parental depression, anxiety or other mood disorders
Substance abuse of one or both parents
Attachment difficulties
Disability or chronic illness of one or both parents
Coercive feeding (including feeding child whilst asleep)
Difficulties at meal times
Poverty
Behavioural disorders
Poor social support
Poor carer understanding
Exposure to traumatic incident/family violence
Neglect of this infant or siblings
Current or past Child Protection involvement
Inadequate absorption: Coeliac disease Chronic liver disease Pancreatic insufficiency eg. Cystic fibrosis Chronic diarrhoea Cow milk protein intolerance
XS calorie utilisation Chronic illness Urinary tract infection Chronic Respiratory disease eg. Cystic Fibrosis Congenital heart disease Diabetes Mellitus Hyperthyroidism
management of failure to thrive
half the size, twice as often
Careful growth charts
treating constipation in children
- movicol
2. stimulant eg. Senna
HSP - complications
Intussuception
causes of eneuresis
treatment of idiopathic
gu malf
dm
utis
tx if over 5:
sublingual desmo
1 wk break every 5 months
causes of eneuresis
treatment of idiopathic
gu malf
dm
utis
tx if over 5:
sublingual desmo
1 wk break every 5 months
what types of cerebral palsy are there?
?causes
?botox
- spastic
- ataxic
- athetoid
- mixed
botox :
ddx’s for vacant episodes
hearing epilepsy visual problems behavioural - adhd / autism learning disability brain tumour iatrogenic - medications
how might you investigate her symptoms?
history - social interactions / regression / reccurent ear infections
what is the pathognomic finding of a petit mal seizure on EEG?
3hz spike and wave
treatment for absence seizures? (petit mal)
ethosuxamide
valproate
investigation of squint
- gross
- corneal light reflex
- cover test
causes of squint?
short / long sightedness
atigmatism
serious neonatal stuff:
issues of prematurity
nec
gastro
neonatal jaundice
resp: bronchopulmonary dysplasia
what is the triad of haemolytic uraemic syndrome
thrombocytopenia
microangiopathic haemolytic anaemia (Coombs test negative)
AKI
what is the common infection causing HUS?
how does this infection cause HUS
E. coli O157
circulating toxins produced by this (verotoxin / shigella) bind to endothelial receptors - causing deposition of fibrin and thrombin in the microvasculature
erythrocytes are damaged as they pass through the microvasculature - get caught and damaged the partially occluded small vessels
platelets sequestered but without the cascade of clotting factors
when can children with HUS go back to school??
after 2 negative stools
presentation of HUS?
The classical presenting feature is profuse diarrhoea that turns bloody 1 to 3 days later
It is rare for the diarrhoea to have been bloody from the outset
management of HUS?
General management includes appropriate fluid and electrolyte management, antihypertensive therapy and dialysis where required.
Circulating volume must be kept up to protect the kidneys; simply replacing losses with crystalloid and keeping up with faecal loss is inadequate, as circulating volume will be lost by vascular leakage.
Where kidney failure occurs, indications for dialysis are as for any other cause of acute kidney failure.
