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Final day prep > Paeds ILAs - 1 and 2 > Flashcards

Paeds ILAs - 1 and 2 Flashcards

1
Q

Septic screen

A

Identify cause of infection in children with pyrexia and non-specific symptoms

FBC - WCC
Acute phase reactant - ESR/CRP
Blood culture
Urine sample

CXR 
LP - Exclude meningitis 
Rapid antigen screen 
PCR 
ABG 
Coagulation profile
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2
Q

Meningitis immediate management

A

ABCDE

A - Maintain the airway
B - High flow O2
C - Bloods + Bolus (20mls/kg)

Community - IM BENPEN

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3
Q

Meningitis antibiotic therapy

A

< 3 months - Ceftriaxone + Amoxicillin (covers GBS)
> 3 months - Ceftriaxone

Adjunctive dexamethasone may reduce risk of complications

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4
Q

What is purpura

A

Bleeding underneath the skin - Non-blanching

Septic shock 
Bacteria release toxins - Causes thrombosis 
Clotting factors used up 
Vessels bleed 
Disseminated intravascular coagulation
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5
Q

Meningitis - Likely causative agent in neonates

A

GBS
E.Coli
Listeria

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6
Q

Meningitis - Likely causative agent in children > 3 months

A

N. Meningitides
Strep pneumonia
HiB

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7
Q

Meningitis ROA and prophylaxis

A

Bacteria carried in ENT
Passed on by sharing respiratory/throat secretions

Coughing, kissing - Living in the same household

Sharing cutlery, toothbrushes or cigarettes

Prophylaxis - Ciprofloxacin and Men C vaccine

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8
Q

Ciprofloxacin side effects

A

N/D/V
Dizziness
Headache

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9
Q

JIA presentation

A

Arthritis < 16 years for > 3 months

Stiffness in the morning and following rest

Systemic - FLAAAP SALMON

  • Fever
  • Lymphadenopathy
  • Anterior uveitis
  • Anorexia
  • Arthritis
  • Pink rash - SALMON
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10
Q

JIE investigations

A

FBC

  • Anaemia
  • WCC ^
  • ESR ^
  • Ferritin ^

ANA +ve

LFT ^

Albumin - LOW

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11
Q

JIA management

A

NSAIDS
Prednisolone
Methotrexate

Alternative therapies

  • Intra-articular corticosteroids
  • Tocilizumab - IL-6
  • Anakinra - IL-1
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12
Q

JIA complications

A 
Chronic anterior uveitis 
Anaemia of chronic disease 
Osteoporosis 
Growth failure 
Valgus deformity
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13
Q

JIA MDT

A 
Physiotherapist 
Occupational therapist 
Specialist nurse 
Ophthalmologist 
Social worker
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14
Q

Kawasaki’s aetiology

A

Idiopathic
Autoimmune
Vasculitis of the small and medium vessels

Japanese
Chinese
Afro-Caribbean

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15
Q

Kawasaki’s presentation

A

6 months - 4 years

CRASH and BURN

Conjunctivitis 
Rash - Polymorphous 
Adenopathy - Cervical and unilateral 
Strawberry tongue and cracked lips 
Hands/feet erythema

BURN - FEVER > 38.5

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16
Q

Kawasaki’s management

A

IV IG - First 10 days

High dose aspirin - Reduce thrombosis risk

Severe…

  • Steroids
  • Anti-TNF - Infliximab
  • Ciclosporin
17
Q

Kawasaki’s complications

A

IV IG - Anaphylaxis
Aspirin - Bleeding and GI irritation

Echo - Check for coronary aneurysms

18
Q

DKA pathophysiology

A

Hyperglycaemia with NO insulin
Sugar cannot pass into cells

Gluconeogenesis and glycogenolysis in the liver

Ketogenesis - Lowers pH

19
Q

DKA precipitants

A

Missed insulin

Infection

20
Q

DKA presentation

A 
Abdominal pain 
Kussmaul breathing - Deep and laboured 
Polydipsia 
Polyuria 
Collapse
21
Q

DKA diagnosis

A

Hyperglycaemic - Glucose > 11
Acidotic - pH < 7.3
HCO3 < 15
Ketones > 3

22
Q

DKA management

A

Fluid bolus
Deficit replacement
Maintenance fluids

  1. Correct potassium
  2. 1 hour later - Give insulin
  3. BM < 15 - Give dextrose
  4. Sodium bicarbonate + Phosphate
23
Q

DKA complications

A

AKI
VTE
Arrhythmia
Cerebral oedema due to fluid overload

24
Q

Fluid calculations

A

0.9% NaCl + 5% glucose
+ 10mmol KCl

Bolus

  • DKA, trauma and neonates - 10ml/kg/day
  • Everything else - 20ml/kg/day

Deficit replacement

  • Dehydrated - 50ml/kg/day
  • Shocked - 100ml/kg/day

Maintenance fluids

  • First 10kg - 100ml/kg/day
  • 10-20kg - 50ml/kg/day
  • Everything else - 20ml/kg/day

HOURLY RATE - DIVIDE BY 24

25
Q

DKA monitoring

A 
Fontanelle tension 
General observations 
Cap refill 
Urine output 
ECG 
Kidney function 
U/E
26
Q

Congenital hypothyroidism aetiology

A

Primary

  • Thyroid dysgenesis
  • Absent thyroid
  • Hypoplasia
  • Dyshormonogenesis - AR - No anatomical abnormalities

Secondary - Lack of iodine

27
Q

Congenital hypothyroidism presentation

A

Jaundice

Distended abdomen
Umbilical hernia

Hypotonia
Hypothermia

Myxoedema

Macroglossia
Large forehead

28
Q

Congenital hypothyroidism investigations

A

Guthrie heel prick test

TSH ^
T4 - LOW

29
Q

Congenital hypothyroidism management

A

Levothyroxine
Same time each day
30 minutes before a meal

30
Q

Congenital hypothyroidism complications

A

Intellectual impairment
Developmental delay
Short stature
Delayed sexual maturity

31
Q

Unwell neonate DDx

A

Sepsis or infection
CHD
Respiratory distress
Hypoglycaemia

Abdominal emergencies

  • NEC
  • Pyloric stenosis
32
Q

Congenital adrenal hyperplasia aetiology

A

Autosomal recessive

21-hydroxylase deficiency
11-beta-hydroxylase deficiency

Aldosterone - LOW
Cortisol - LOW
Androgens ^^^

33
Q

CAH presentation

A

Low aldosterone

  • HYPOnatraemia
  • HYPERkalaemia
  • HYPOtension

Low cortisol

  • HYPOglycaemia
  • ACTH ^

Androgens ^

  • Female virilisation
  • Clitoral hypertrophy
  • Precocious puberty
34
Q

CAH investigations

A

Bloods

  • HYPOnatraemia
  • HYPERkalaemia
  • ACTH ^
  • HYPOglycaemia

17 alpha hydroxyprogesterone ^

Metabolic acidosis

Adrenal USS

35
Q

CAH management

A

Aldosterone replacement - Fludrocortisone

Hydrocortisol replacement - Hydrocortisone

Final day prep (8 decks)

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