Paeds peer teachings Flashcards
1
Q
Breathless (L to R) congenital defects
A
VSD PDA ASD
2
Q
Cyanotic (R to L) congenital defects
A
Tetralogy of fallot Transposition of the great arteries
3
Q
Pulse in PDA
A
Bounding
4
Q
Treatment of PDA
A
NSAIDs or surgical ligation
5
Q
4 components of tetralogy of fallot
A
Pulmonary stenosis VSD Overriding aorta Right ventricular hypertorphy
6
Q
Signs and symptoms of tetralogy of fallot
A
Severe cyanosis, HY hypercyanotic spells on exercise, crying and defecating. Ejection systolic murmur Clubbing
7
Q
Management of tetralogy of fallot
A
Surgery at 6 months, close VSD and relieve pulmonary outflow obstruction
8
Q
How does transposition of the great arteries work
A
Pulmonary artery and aorta swap.
9
Q
Signs and symptoms of transposition of great arteries
A
Presents at 2 days with severe cyanosis (after PDA closes)
10
Q
Management of transposition of the great arteries
A
Prostaglandin infusion to maintain PDA Surgical- atrial sepstostomy
11
Q
Cardiac outflow obstruction in a well child
A
Pulmonary or aortic steonsis
12
Q
Cardiac outflow obstruction in a . sick child
A
Coarctation of the aorta
13
Q
Describe pulmonary stenosis
A
Pulmonary valve leaflets partially fused together, obstructs RV outflow
14
Q
Signs and symptoms of pulmonary stenosis
A
Asymptomatic. Ejection systolic murmur and palpable thrill
15
Q
Where will the ejection systolic murmur be heard in pulmonary stenosis
A
Left upper sternal edge
16
Q
Where will the ejection systolic murmur be heard in pulmonary stenosis
A
Right upper sternal edge
17
Q
What does bile stained vomit suggest
A
Intestinal obstruction
18
Q
What does haematemesis suggest
A
Pepti ulceration Gastritis Oesophageal varices
19
Q
What does projectile vomiting suggest
A
Pyloric stenosis
20
Q
What does abdominal pain on movement suggest
A
Surgical abdomen- appendicitis
21
Q
What does blood in the stool suggest
A
Intussusception Gastroenteritis
22
Q
What does severe dehydration suggest
A
Severe gastroenteritis Diabetic ketoacidosis Systemic infection
23
Q
What are headache or seizures a red flag for
A
Raised intracranial pressure
24
Q
What is failure to thrive a red flag for in a vomiting infant
A
GORD Coeliac disease
25
Blood results for a vomitting child
Hypokalaemic Hypochlroaemic Metabolic alkalosis Dehydration
26
Gold standard test for pyloric stenosis
Test feed
27
How does a test feed work
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
28
How do you treat pyloric stenosis first line
Calculate and commence maintenance fluids
29
What is the surgery for pyloric stenosis
Ramstedts pyloromyotomy
30
What are the three components of fluids
Bolus (severe dehydration), maintenance (as nil by mouth), replacement (to replace ongoing NG losses)
31
GORD symptoms
Recurrent regurgitation, feeding difficulties, arching of back and neck, sore throat
32
Investigation for GORD
pH impedance study, 24 hour pH probe
33
Management of GORD
Smaller and more frequent meals, feed thickeners, optimise position
34
Symptoms of cows milk protein intolerance
Abdominal pain, eczema, flatulence, bloody stools, diarrhoea or constipation
35
Investigation of cows milk protein intolerance
Skin prick or specific IgE antibody testing
36
Management of cows milk protein intolerance
Cows milk elimination diet, hypoallergenic infant formula, mother to avoid cows milk
37
Symptoms of intestinal obstruction
Billous vomiting, constipation, abdominal pain
38
Investigation of intestinal obstruction
Ultrasound, abdominal X ray, contrast study
39
Treatment of intestinal obstruction
Surgical intervention
40
Symptoms of vomiting caused by gastroenteritis
Diarrhoea and vomitting and abdominal pain
41
Symptoms of vomitting caused by UTI
Isolated vomitting
42
Symptoms of vomitting caused by meningitis
Also altered responsiveness
43
Investigation of vomiting caused by infection
Find the source of infection: cultures, urine dipstick, lumbar puncture
44
What three things are needed for a fluid prescription
Fluid constituents and bag size (500mL) Rate of administration (mL/hr) Signature of the prescriber
45
How do you estimate the weight of a child
(Age +4) x 2
46
What questions do you want to ask before you prescribe fluids
Weight? change in past 24hr Fluid input and output in past 24hr? Fluid status? Recent bloods?
47
What type of fluid do you give normally for maintenance
NaCl 0.9% + Dextrose 5% + KCl 10mmol
48
What is an upper limit for girls fluids in 24 hr
2 litres
49
What is an upper limit for boys fluids in 24 hr
2.5 litres
50
fluid requirement for 0-10kg
100mL/kg
51
fluid requirement for 10-20kg
50mL/kg
52
fluid requirement for above 20kg
20mL/kg
53
How to calculate percentage dehydration if weights not known
clinical assessment
54
How to calculate percentage dehydration
well weight (kg) - current weight/ well weight x100
55
How do you calculate the fluid defecit (mL)
%dehydration x wieght x 10
56
What percentage dehydration will someone with increased thirst but no others signs of dehydration be
Less than 5%
57
If a child is dehydrated but no shock what do you assume the % dehydration to be
5
58
Red flags of dehydration
Unwell or deteriorating Altered responsiveness Sunken eyes Tachycardia Tachypnoea Reduced skin turgor
59
Signs of clinical shock
Decreased LOC Pale or mottled skin Cold extremeties Weak peripheral pulses Prolonged cap refill time Hypotension
60
What percentage dehydration is someone in shock
8-10%
61
What fluid is in fluid boluses
Sodium Chloride at 0.9% at 20ml/kg
62
When might you need a 10ml/kg bolus
Diabetic ketoacidosis Trauma Primary cardiac pathology e.g. heart failure
63
Do you include boluses in total fluid requirement calculations
No
64
What should you do if youve given more than 3 boluses
Call for paediatric intensive care support in case the child deteriorates into pulmonary oedema
65
What fluid do you give to neonates
10% dextrose
66
How much do you give in first day of life
50
67
how much do you give in second day of life
70
68
how much do you give in 3rd day of life
90
69
how much do you give in 4th day of life
110
70
how much do you give in 5th day of life
130
71
How do you add electrolyte support from day 2 onwards in fluid support of neonates
3mmol Na, 2mmol K
72
Name the causes of wheeze
Asthma Bronchiolitis Viral induzed wheeze Pneumonia
73
Name the causes of stridor
Croup Epiglottitis Bacterial tracheitis Diptheria Laryngomalacia Inhaled foreign body Angioedema Anaphylaxis
74
Signs of respiratory distress
Cyanosis Tracheal tug Subcostal and intercostal recessions Hypoxia Tahcypnoea Wheeze (Stridor, head bobbing)
75
Presentation of pneumonia
Cough, fever, tachypnoea, chest recession, nasal flaring, head bobbing, hypoxia, hypotension, confusion, shock
76
Which is the most common cause of pneumonia
Streptococcus pneumonia
77
What pneumonia occurs in prevaccinated and neonates
Group B strep
78
What x ray findings would make you think the pneumonia was caused by staphylococcus aureus
Pneumatoceles (round air filled cavities) and consolidations in multiple lobes
79
Which pneumonia occurs in prevaccinated/ unvaccinated children
Haemophilus influenza
80
What organism is to blame if the child gets pneumonia and also erythema multiforme
Mycoplasma pneumonia
81
What is the most common and one other viral cause of pneumonia
RSV is the most common Influenza can also cause
82
Which children get more viral pneumonia
Under 2s
83
Investigations for pneumonia or sepsis
Chest Xray Blood cultures and sensitivities FBC Sputum cultures and throat swabs Viral PCR Capillary blood gas
84
Neonates pneumonia treatment
IV broad sprectrum antibiotics
85
Older children pneumonia first line
Amoxicillin
86
Older children second line treatment for pneumonia
Erythromycin
87
What do you add on to pneumonia treatment if associated with influenza
Co amoxiclav
88
Why do you add in erythromycin to pneumonia treatment
Covers the atypical pneumonia
89
Presentation of acute asthma attack
Progressively worsening shortening of breath, signs of respiratory distress, tachypnoea, expiratory wheeze, reduced air entry
90
What is an ominous sign in an acute asthma attack
Silent chest
91
Signs of moderate asthma attack
SpO2 \>92 no clinical features of severe asthma
92
Signs of a severe asthma attack
SpO2 \<92 Too breathless to talk or feed Heart rate over 140 Resp rate over 40 Use of accessory neck muscles
93
Signs of a life threatening asthma attack
SpO2 \<92 Silent chest Poor respiratory effort Agitation Altered LOC Cyanosis
94
What is the limits on how many puffs of salbutamol you can have in an acute attack
1 puff every 30-60s, up to a max of 10
95
What are the first 4 steps in acute asthma management
1. supplementary high flow oxygen 2. nebulised salbutamol 3. nebulised ipratropium bromide 4. oral prednisolone
96
What can you give IV in an acute asthma attack
Hydrocortisone Salbutamol Aminophylline Magnesium sulphate
97
What should the peak flow be in an asthma patient be after treatment, before going home
Over 75%
98
What can salbutamol cause
Tachycardia, hypokalaemia and tremor
99
What are the other things that need doing during an acute asthma attack
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
What is the atopic triad
Asthma Eczema Hay fever (and food allergies)
101
What are the 1st 2nd 3rd line treatments of asthma in an under 5
SABA- Salbutamol Low dose corticosteroid LTRA- oral montelukast
102
What is the treatment regime for asthma in an older child
SABA Low dose CSI LABA- Salmeterol Medium dose CSI LTRA High dose CSI
103
Questions for the asthmatic child
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
Symptoms of anaphylaxis
Urticaria, itching, swelling of lips, tongue, eyes. Wheeze, stridor, SOB, tachycardia, abdo pain, collapse, hypotension
105
Management of anaphylaxis
ABCDE, oxygen, IV fluids, IM adrenaline, hydrocortisone IV and antihistamines oral
106
How often can you repeat IM adrenaline
After 5 mins
107
What should you measure in anaphylaxis
Tryptase
108
Presentation of viral induced wheeze
2yo, cold like symptoms, fever, runny nose and an expiratory wheeze
109
Cause of viral induced wheeze
RSV or rhinovirus Small amount of oedema and narrowing leads to a proportionally larger restriction in airflow
110
What makes you think viral induced wheeze not asthma
Under 3 No atopic history Only occurs during viral infections
111
Treatment of viral induced wheeze
Supplementary oxygen Salbutamol and inhaled corticosteroids and montelukast
112
Bronchiolitis cause
Winter borne viral URTI in under 2s, most common RSV
113
2 key symptoms of bronchiolitis
Wheeze and inspiratory crackles
114
Pathology of bronchiolitis
Mucus production and inflammation results in airway narrowing and alveoli collapse
115
Diagnosis of bronchiolitis
Nasal swab
116
Chest X ray findings in bronchiolitis
Broken ribs, flattened diaphragm, atelectasis (sac collapse)
117
Red flags for bronchiolitis presentation
Premature, downs or CF Less than 3/4 of normal milk intake Dehydration signs Oxygen sats below 92 Moderate to severe resp distress
118
Treatments for bronchiolitis
Consider NG feeds and IV fluids High flow humidified oxygen CPAP
119
What is palivizumab
Monoclonal antibody against RSV
120
Who can get palivizumab and how often
Monthly CF, premature, chronic lung disease, immunodeficient kids
121
Monitoring for bronchiolitis
Capillary blood gas (T2 Resp failure) O2 % (over 92)
122
Presentation of laryngotracheobronchitis
6mnths-6yrs Stridor, barking cough and coryzal
123
Causative organism in croup
Parainfluenza virus
124
Pathology of croup
URTI causes oedema in the larynx
125
Key symptoms of croup
Barking or seal like cough Stridor/ hoarse voice
126
Treatment of croup
Dexamethasone 0.15mg/kg Oxygen Nebulised budesonide and adrenalin
127
What shouldnt you do
Examine the throat
128
Presentation of acute epiglottitis
Foreign child comes in drooling, unable to speak, inspiratory stridor. Sitting upright and leaning forwards helps.
129
Causative organism of acute epiglottitis
Haemophilus influenza b
130
Signs and symptoms of acute epiglottitis
Drooling, sore throat, dysphagia, stridor, fever, septic
131
What does laryngoscopy show in acute epiglottitis
Beefy red stiff oedematous epiglottis
132
What does a lateral x ray of the neck show in acute epiglottitis
Thumb sign
133
Treatment of acute epiglottitis
ITU- Nasotracheal intubation. IV ceftriazone and dexamethasone
134
Which drug for close contact prophylaxis for haemophilus influenza b
Rifampicin
135
Presentation of laryngomalacia
6 month old infant, intermittent chronic stridor worse on feeding and crying. No other signs of respiratory distress
136
Pathology of laryngomalacia
Congenital. Supraglottic larynx causes partial airway obstruction. Inspiratory stridor when larynx flops across the airway
137
What is an omega shape epiglottis on bronchoscopy suggestive of
Laryngomalacia
138
What is the treatment for laryngomalacia
Leave Should resolve within 18 months
139
What is the presentation of whooping cough
No vaccine. Coryzal, violently coughing so much it vomits, gasps, inpiratory whoop. Goes blue. Worse at night. 100 day cough
140
Causative organism of whooping cough
Bordetella pertussis
141
What does bordetella pertusis look like under the microscope
Gram negative cocobacilli
142
Diagnosis of whooping cough
Per nasal pharynx swabs and culture for pertussis Anti-pertussis toxin IgG
143
Treatment for whooping couhg
Part of the 6 in vaccine Erythromycin
144
When is the 6 in 1 vaccine given
2, 3, 4 months and 3-5 years
145
Complications of whooping cough
Bronchiectasis and pneumothorax
146
Which specific mutation causes cystic fibrosis
delta F508
147
What causes cystic fibrosis
Autosomal recessive Cystic fibrosis transmembrane conductance regulatory gene on chromosome 7
148
Key signs and symptoms of cystic fibrosis
Thick pancreatic and biliary secretions Thick airway secretions (=bacterial colonisation) Absence of the vas deferens Meconium ileus
149
What is meconium ileus
Not passing meconium within 24 hours, causing abdominal distension and vomiting
150
Presentation of cystic fibrosis
Salty tasting baby Nasal polyps Finger clubbing Failure to thrive Foul smelling, floating poos
151
Later presentation of cystic fibrosis
recurrent lower respiratory tract infections, failure to thrive or pancreatitis
152
What is the gold standard for cystic fibrosis diagnosis
Sweat test
153
How else can cystic fibrosis be tested for
Newborn blood spot testign Genetic testing for CTFR gene by amniocentesis or CVS
154
How do you treat pseudomonas colonisation
Nebulised antibiotics (tobramycin) and oral ciprofloxacin
155
How do you treat staph aureus colonisation
Prophylactic flucoxacillin
