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Phase 3a > Paeds peer teachings > Flashcards

Paeds peer teachings Flashcards

1
Q

Breathless (L to R) congenital defects

A

VSD PDA ASD

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2
Q

Cyanotic (R to L) congenital defects

A

Tetralogy of fallot Transposition of the great arteries

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3
Q

Pulse in PDA

A

Bounding

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4
Q

Treatment of PDA

A

NSAIDs or surgical ligation

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5
Q

4 components of tetralogy of fallot

A

Pulmonary stenosis VSD Overriding aorta Right ventricular hypertorphy

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6
Q

Signs and symptoms of tetralogy of fallot

A

Severe cyanosis, HY hypercyanotic spells on exercise, crying and defecating. Ejection systolic murmur Clubbing

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7
Q

Management of tetralogy of fallot

A

Surgery at 6 months, close VSD and relieve pulmonary outflow obstruction

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8
Q

How does transposition of the great arteries work

A

Pulmonary artery and aorta swap.

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9
Q

Signs and symptoms of transposition of great arteries

A

Presents at 2 days with severe cyanosis (after PDA closes)

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10
Q

Management of transposition of the great arteries

A

Prostaglandin infusion to maintain PDA Surgical- atrial sepstostomy

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11
Q

Cardiac outflow obstruction in a well child

A

Pulmonary or aortic steonsis

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12
Q

Cardiac outflow obstruction in a . sick child

A

Coarctation of the aorta

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13
Q

Describe pulmonary stenosis

A

Pulmonary valve leaflets partially fused together, obstructs RV outflow

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14
Q

Signs and symptoms of pulmonary stenosis

A

Asymptomatic. Ejection systolic murmur and palpable thrill

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15
Q

Where will the ejection systolic murmur be heard in pulmonary stenosis

A

Left upper sternal edge

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16
Q

Where will the ejection systolic murmur be heard in pulmonary stenosis

A

Right upper sternal edge

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17
Q

What does bile stained vomit suggest

A

Intestinal obstruction

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18
Q

What does haematemesis suggest

A

Pepti ulceration Gastritis Oesophageal varices

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19
Q

What does projectile vomiting suggest

A

Pyloric stenosis

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20
Q

What does abdominal pain on movement suggest

A

Surgical abdomen- appendicitis

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21
Q

What does blood in the stool suggest

A

Intussusception Gastroenteritis

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22
Q

What does severe dehydration suggest

A

Severe gastroenteritis Diabetic ketoacidosis Systemic infection

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23
Q

What are headache or seizures a red flag for

A

Raised intracranial pressure

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24
Q

What is failure to thrive a red flag for in a vomiting infant

A

GORD Coeliac disease

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25
Q

Blood results for a vomitting child

A

Hypokalaemic Hypochlroaemic Metabolic alkalosis Dehydration

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26
Q

Gold standard test for pyloric stenosis

A

Test feed

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27
Q

How does a test feed work

A

NG tube insertion and aspiration to empty the stomach, small feed of dioralyte. Examiners fingers placed just below the liver edge- olive mass palpable indicates a stenosed pylorus

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28
Q

How do you treat pyloric stenosis first line

A

Calculate and commence maintenance fluids

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29
Q

What is the surgery for pyloric stenosis

A

Ramstedts pyloromyotomy

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30
Q

What are the three components of fluids

A

Bolus (severe dehydration), maintenance (as nil by mouth), replacement (to replace ongoing NG losses)

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31
Q

GORD symptoms

A

Recurrent regurgitation, feeding difficulties, arching of back and neck, sore throat

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32
Q

Investigation for GORD

A

pH impedance study, 24 hour pH probe

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33
Q

Management of GORD

A

Smaller and more frequent meals, feed thickeners, optimise position

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34
Q

Symptoms of cows milk protein intolerance

A

Abdominal pain, eczema, flatulence, bloody stools, diarrhoea or constipation

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35
Q

Investigation of cows milk protein intolerance

A

Skin prick or specific IgE antibody testing

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36
Q

Management of cows milk protein intolerance

A

Cows milk elimination diet, hypoallergenic infant formula, mother to avoid cows milk

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37
Q

Symptoms of intestinal obstruction

A

Billous vomiting, constipation, abdominal pain

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38
Q

Investigation of intestinal obstruction

A

Ultrasound, abdominal X ray, contrast study

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39
Q

Treatment of intestinal obstruction

A

Surgical intervention

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40
Q

Symptoms of vomiting caused by gastroenteritis

A

Diarrhoea and vomitting and abdominal pain

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41
Q

Symptoms of vomitting caused by UTI

A

Isolated vomitting

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42
Q

Symptoms of vomitting caused by meningitis

A

Also altered responsiveness

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43
Q

Investigation of vomiting caused by infection

A

Find the source of infection: cultures, urine dipstick, lumbar puncture

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44
Q

What three things are needed for a fluid prescription

A

Fluid constituents and bag size (500mL) Rate of administration (mL/hr) Signature of the prescriber

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45
Q

How do you estimate the weight of a child

A

(Age +4) x 2

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46
Q

What questions do you want to ask before you prescribe fluids

A

Weight? change in past 24hr Fluid input and output in past 24hr? Fluid status? Recent bloods?

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47
Q

What type of fluid do you give normally for maintenance

A

NaCl 0.9% + Dextrose 5% + KCl 10mmol

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48
Q

What is an upper limit for girls fluids in 24 hr

A

2 litres

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49
Q

What is an upper limit for boys fluids in 24 hr

A

2.5 litres

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50
Q

fluid requirement for 0-10kg

A

100mL/kg

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51
Q

fluid requirement for 10-20kg

A

50mL/kg

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52
Q

fluid requirement for above 20kg

A

20mL/kg

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53
Q

How to calculate percentage dehydration if weights not known

A

clinical assessment

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54
Q

How to calculate percentage dehydration

A

well weight (kg) - current weight/ well weight x100

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55
Q

How do you calculate the fluid defecit (mL)

A

%dehydration x wieght x 10

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56
Q

What percentage dehydration will someone with increased thirst but no others signs of dehydration be

A

Less than 5%

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57
Q

If a child is dehydrated but no shock what do you assume the % dehydration to be

A

5

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58
Q

Red flags of dehydration

A

Unwell or deteriorating Altered responsiveness Sunken eyes Tachycardia Tachypnoea Reduced skin turgor

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59
Q

Signs of clinical shock

A

Decreased LOC Pale or mottled skin Cold extremeties Weak peripheral pulses Prolonged cap refill time Hypotension

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60
Q

What percentage dehydration is someone in shock

A

8-10%

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61
Q

What fluid is in fluid boluses

A

Sodium Chloride at 0.9% at 20ml/kg

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62
Q

When might you need a 10ml/kg bolus

A

Diabetic ketoacidosis Trauma Primary cardiac pathology e.g. heart failure

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63
Q

Do you include boluses in total fluid requirement calculations

A

No

64
Q

What should you do if youve given more than 3 boluses

A

Call for paediatric intensive care support in case the child deteriorates into pulmonary oedema

65
Q

What fluid do you give to neonates

A

10% dextrose

66
Q

How much do you give in first day of life

A

50

67
Q

how much do you give in second day of life

A

70

68
Q

how much do you give in 3rd day of life

A

90

69
Q

how much do you give in 4th day of life

A

110

70
Q

how much do you give in 5th day of life

A

130

71
Q

How do you add electrolyte support from day 2 onwards in fluid support of neonates

A

3mmol Na, 2mmol K

72
Q

Name the causes of wheeze

A

Asthma Bronchiolitis Viral induzed wheeze Pneumonia

73
Q

Name the causes of stridor

A

Croup Epiglottitis Bacterial tracheitis Diptheria Laryngomalacia Inhaled foreign body Angioedema Anaphylaxis

74
Q

Signs of respiratory distress

A

Cyanosis Tracheal tug Subcostal and intercostal recessions Hypoxia Tahcypnoea Wheeze (Stridor, head bobbing)

75
Q

Presentation of pneumonia

A

Cough, fever, tachypnoea, chest recession, nasal flaring, head bobbing, hypoxia, hypotension, confusion, shock

76
Q

Which is the most common cause of pneumonia

A

Streptococcus pneumonia

77
Q

What pneumonia occurs in prevaccinated and neonates

A

Group B strep

78
Q

What x ray findings would make you think the pneumonia was caused by staphylococcus aureus

A

Pneumatoceles (round air filled cavities) and consolidations in multiple lobes

79
Q

Which pneumonia occurs in prevaccinated/ unvaccinated children

A

Haemophilus influenza

80
Q

What organism is to blame if the child gets pneumonia and also erythema multiforme

A

Mycoplasma pneumonia

81
Q

What is the most common and one other viral cause of pneumonia

A

RSV is the most common Influenza can also cause

82
Q

Which children get more viral pneumonia

A

Under 2s

83
Q

Investigations for pneumonia or sepsis

A

Chest Xray Blood cultures and sensitivities FBC Sputum cultures and throat swabs Viral PCR Capillary blood gas

84
Q

Neonates pneumonia treatment

A

IV broad sprectrum antibiotics

85
Q

Older children pneumonia first line

A

Amoxicillin

86
Q

Older children second line treatment for pneumonia

A

Erythromycin

87
Q

What do you add on to pneumonia treatment if associated with influenza

A

Co amoxiclav

88
Q

Why do you add in erythromycin to pneumonia treatment

A

Covers the atypical pneumonia

89
Q

Presentation of acute asthma attack

A

Progressively worsening shortening of breath, signs of respiratory distress, tachypnoea, expiratory wheeze, reduced air entry

90
Q

What is an ominous sign in an acute asthma attack

A

Silent chest

91
Q

Signs of moderate asthma attack

A

SpO2 >92 no clinical features of severe asthma

92
Q

Signs of a severe asthma attack

A

SpO2 <92 Too breathless to talk or feed Heart rate over 140 Resp rate over 40 Use of accessory neck muscles

93
Q

Signs of a life threatening asthma attack

A

SpO2 <92 Silent chest Poor respiratory effort Agitation Altered LOC Cyanosis

94
Q

What is the limits on how many puffs of salbutamol you can have in an acute attack

A

1 puff every 30-60s, up to a max of 10

95
Q

What are the first 4 steps in acute asthma management

A
  1. supplementary high flow oxygen 2. nebulised salbutamol 3. nebulised ipratropium bromide 4. oral prednisolone
96
Q

What can you give IV in an acute asthma attack

A

Hydrocortisone Salbutamol Aminophylline Magnesium sulphate

97
Q

What should the peak flow be in an asthma patient be after treatment, before going home

A

Over 75%

98
Q

What can salbutamol cause

A

Tachycardia, hypokalaemia and tremor

99
Q

What are the other things that need doing during an acute asthma attack

A

Call anaesthetist and intensive care unit Intubation and ventilation Prescribe reducing routine of salbutamol Finish course of pred Safety net info, 1 week GP follow up Written asthma action plan

100
Q

What is the atopic triad

A

Asthma Eczema Hay fever (and food allergies)

101
Q

What are the 1st 2nd 3rd line treatments of asthma in an under 5

A

SABA- Salbutamol Low dose corticosteroid LTRA- oral montelukast

102
Q

What is the treatment regime for asthma in an older child

A

SABA Low dose CSI LABA- Salmeterol Medium dose CSI LTRA High dose CSI

103
Q

Questions for the asthmatic child

A

What are your symptoms When do you get them Worse at night or morning How often do you use your blue inhaler Have you been hospitalised before Has your exercise tolerance reduced Is it worse in the cold What seems to trigger them Do you have hayfever or allergies Family history

104
Q

Symptoms of anaphylaxis

A

Urticaria, itching, swelling of lips, tongue, eyes. Wheeze, stridor, SOB, tachycardia, abdo pain, collapse, hypotension

105
Q

Management of anaphylaxis

A

ABCDE, oxygen, IV fluids, IM adrenaline, hydrocortisone IV and antihistamines oral

106
Q

How often can you repeat IM adrenaline

A

After 5 mins

107
Q

What should you measure in anaphylaxis

A

Tryptase

108
Q

Presentation of viral induced wheeze

A

2yo, cold like symptoms, fever, runny nose and an expiratory wheeze

109
Q

Cause of viral induced wheeze

A

RSV or rhinovirus Small amount of oedema and narrowing leads to a proportionally larger restriction in airflow

110
Q

What makes you think viral induced wheeze not asthma

A

Under 3 No atopic history Only occurs during viral infections

111
Q

Treatment of viral induced wheeze

A

Supplementary oxygen Salbutamol and inhaled corticosteroids and montelukast

112
Q

Bronchiolitis cause

A

Winter borne viral URTI in under 2s, most common RSV

113
Q

2 key symptoms of bronchiolitis

A

Wheeze and inspiratory crackles

114
Q

Pathology of bronchiolitis

A

Mucus production and inflammation results in airway narrowing and alveoli collapse

115
Q

Diagnosis of bronchiolitis

A

Nasal swab

116
Q

Chest X ray findings in bronchiolitis

A

Broken ribs, flattened diaphragm, atelectasis (sac collapse)

117
Q

Red flags for bronchiolitis presentation

A

Premature, downs or CF Less than 3/4 of normal milk intake Dehydration signs Oxygen sats below 92 Moderate to severe resp distress

118
Q

Treatments for bronchiolitis

A

Consider NG feeds and IV fluids High flow humidified oxygen CPAP

119
Q

What is palivizumab

A

Monoclonal antibody against RSV

120
Q

Who can get palivizumab and how often

A

Monthly CF, premature, chronic lung disease, immunodeficient kids

121
Q

Monitoring for bronchiolitis

A

Capillary blood gas (T2 Resp failure) O2 % (over 92)

122
Q

Presentation of laryngotracheobronchitis

A

6mnths-6yrs Stridor, barking cough and coryzal

123
Q

Causative organism in croup

A

Parainfluenza virus

124
Q

Pathology of croup

A

URTI causes oedema in the larynx

125
Q

Key symptoms of croup

A

Barking or seal like cough Stridor/ hoarse voice

126
Q

Treatment of croup

A

Dexamethasone 0.15mg/kg Oxygen Nebulised budesonide and adrenalin

127
Q

What shouldnt you do

A

Examine the throat

128
Q

Presentation of acute epiglottitis

A

Foreign child comes in drooling, unable to speak, inspiratory stridor. Sitting upright and leaning forwards helps.

129
Q

Causative organism of acute epiglottitis

A

Haemophilus influenza b

130
Q

Signs and symptoms of acute epiglottitis

A

Drooling, sore throat, dysphagia, stridor, fever, septic

131
Q

What does laryngoscopy show in acute epiglottitis

A

Beefy red stiff oedematous epiglottis

132
Q

What does a lateral x ray of the neck show in acute epiglottitis

A

Thumb sign

133
Q

Treatment of acute epiglottitis

A

ITU- Nasotracheal intubation. IV ceftriazone and dexamethasone

134
Q

Which drug for close contact prophylaxis for haemophilus influenza b

A

Rifampicin

135
Q

Presentation of laryngomalacia

A

6 month old infant, intermittent chronic stridor worse on feeding and crying. No other signs of respiratory distress

136
Q

Pathology of laryngomalacia

A

Congenital. Supraglottic larynx causes partial airway obstruction. Inspiratory stridor when larynx flops across the airway

137
Q

What is an omega shape epiglottis on bronchoscopy suggestive of

A

Laryngomalacia

138
Q

What is the treatment for laryngomalacia

A

Leave Should resolve within 18 months

139
Q

What is the presentation of whooping cough

A

No vaccine. Coryzal, violently coughing so much it vomits, gasps, inpiratory whoop. Goes blue. Worse at night. 100 day cough

140
Q

Causative organism of whooping cough

A

Bordetella pertussis

141
Q

What does bordetella pertusis look like under the microscope

A

Gram negative cocobacilli

142
Q

Diagnosis of whooping cough

A

Per nasal pharynx swabs and culture for pertussis Anti-pertussis toxin IgG

143
Q

Treatment for whooping couhg

A

Part of the 6 in vaccine Erythromycin

144
Q

When is the 6 in 1 vaccine given

A

2, 3, 4 months and 3-5 years

145
Q

Complications of whooping cough

A

Bronchiectasis and pneumothorax

146
Q

Which specific mutation causes cystic fibrosis

A

delta F508

147
Q

What causes cystic fibrosis

A

Autosomal recessive Cystic fibrosis transmembrane conductance regulatory gene on chromosome 7

148
Q

Key signs and symptoms of cystic fibrosis

A

Thick pancreatic and biliary secretions Thick airway secretions (=bacterial colonisation) Absence of the vas deferens Meconium ileus

149
Q

What is meconium ileus

A

Not passing meconium within 24 hours, causing abdominal distension and vomiting

150
Q

Presentation of cystic fibrosis

A

Salty tasting baby Nasal polyps Finger clubbing Failure to thrive Foul smelling, floating poos

151
Q

Later presentation of cystic fibrosis

A

recurrent lower respiratory tract infections, failure to thrive or pancreatitis

152
Q

What is the gold standard for cystic fibrosis diagnosis

A

Sweat test

153
Q

How else can cystic fibrosis be tested for

A

Newborn blood spot testign Genetic testing for CTFR gene by amniocentesis or CVS

154
Q

How do you treat pseudomonas colonisation

A

Nebulised antibiotics (tobramycin) and oral ciprofloxacin

155
Q

How do you treat staph aureus colonisation

A

Prophylactic flucoxacillin

Phase 3a (9 decks)

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