Paeds things Flashcards

1
Q

Definition of BRUE

A

Less than 12 months old

Duration <1min (typically 20-30 seconds)

Sudden onset, accompanied by return to baseline state

Characterised by 1+ of:

  • cyanosis or pallor (COLOUR)
  • absent, decreased or irregular breathing (BREATHING)
  • marked change in tone (hypertonia or hypotonia) (TONE)
  • altered level of responsiveness (ALERTNESS)
  • not explained by identifiable medical conditions
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2
Q

Low risk BRUE criteria

A

No concerning features on history or examination and all of:

  • age >60 days
  • born 32+ weeks gestation and corrected gestational age 45+ weeks
  • no CPR by trained healthcare professionals
  • first event
  • event lasted <1 minute
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3
Q

Pyloric stenosis key facts

A

2-6 weeks of age
Progressive non-bilious vomiting

Risk factors

  • male
  • first born
  • parental history of HPS (especially if mother affected)

Hypochloraemic hypokalaemia metabolic alkalosis

Management priorities

  • treat dehydration + electrolytes as indicated
  • allow to continue feeding (with NG sited) for comfort, unless concerns about aspiration
  • USS diagnosis
  • surgical referral
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4
Q

Jaundice key points

A
Risk factors
MATERNAL
- blood group O, Rh -
- FHx, East Asian/mediterranean descent
- poorly controlled diabetes
- previously jaundiced baby requiring phototherapy
NEONATAL
- breast fed, and/or low volume feeds
- haematoma or bruising
- polycythaemia
- haemolytic factors
- bowel obstruction
- infection, preterm, male

Urgent investigation if <24 hours old, including septic screen

If over 24 hours and well child, plot TSB on nomogram

If conjugated hyperbilirubinaemia, further workup required

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5
Q

the MISFITS

A

T: trauma (including NAI), tumour, thermal
H: heart disease, hypovolaemia, hypoxia
E: endocrine (CAH, DM, thyroid)

M: metabolic disturbances (electrolytes)
I: inborn errors of metabolism
S: seizures or CNS abnormalities
F: formula dilution or over concentration (Na+)
I: intestinal catastrophes (intussusception, volvulus, NEC)
T: toxins (including home remedies eg baking soda for burping)
S: sepsis

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6
Q

Haemolytic uraemic syndrome pentad

A

(FAT RN)

F: fever
A: anaemia (microangiopathic haemolytic)
T: thrombocytopaenia

R: renal problems
N: neurological problems (headaches, confusion, seizures) - more likely in TTP

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7
Q

Intussusception peak incidence and clinical features

A

PEAK: 4-10 months (range up to 36 months)

FEATURES

  • abrupt onset
  • intermittent, colicky abdominal pain
  • episodes of crying and pulling the knees up
  • pallor (with episodes)
  • vomiting
  • often quite well between episodes
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8
Q

Limp in a toddler (1-4 yrs)

A

Developmental hip dysplasia

Toddlers fracture

Transient synovitis of the hip (irritable hip)

Child abuse/NAI

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9
Q

Limp in a child (4-10 yrs)

A

Transient synovitis of the hip (irritable hip)

Perthes disease

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10
Q

Limp in an adolescent (10+ years)

A

Slipped upper femoral epiphyses (SUFE)

overuse syndrome

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11
Q

Limp in any age group

A

Infections (OM, septic arthritis, soft tissue, viral myositis)

Trauma

NAI

Malignancy (ALL, bone tumour)

Rheumatological disorders and reactive arthritis

Intra-abdominal pathology (eg appendicitis)

Inguinoscrotal disorders (eg testicular torsion)

Functional

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12
Q

Irritable hip

A

3-8 years

history of recent viral URTI

usually able to walk but painful

child otherwise well

mild-moderate ROM loss, especially IR

diagnosis of exclusion

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13
Q

Perthes disease

A

Avascular necrosis of capital femoral epiphysis

2-12 years (mostly 4-8)

20% bilateral

restricted ROM on exam

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14
Q

SUFE

A

Late childhood/early adolescence

Often overweight

Hip or knee pain + limp

Hip appears externally rotated and shortened

Decreased ROM especially IR

May be bilateral

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15
Q

Kawasaki disease diagnosis

A

Fever at least 5 days without any other explanation, plus 4 of 5:

  1. bilateral bulbar conjunctival injection
  2. oral mucous membrane changes, including injected or fissured lips, injected pharynx, or strawberry tongue
  3. peripheral extremity changes, including erythema of palms or soles, oedema of hands or feet, periungual desquamation
  4. polymorphous rash
  5. cervical lymphadenopathy (at least one LN >1.5cm diameter)
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16
Q

Kawasaki disease treatment

A
  • IVIG
  • aspirin (30-50mg/kg daily in 4 divided doses)
  • +/- steroids

monitor for complications

  • coronary artery aneurysms
  • heart failure
  • arrhythmia
  • MI
  • peripheral arterial occlusion
17
Q

Bronchiolitis: risk factors for more serious illness

A

gestational age <37 weeks

chronological age at presentation <10 weeks

postnatal exposure to cigarette smoke

breastfed for less than 2 months

failure to thrive

chronic lung disease

chronic neurological conditions

indigenous

immunodeficiency

18
Q

Paediatric appendicitis score

A

For use in kids 3-18 years

  • RLQ tenderness to cough, percussion, or hopping (+2)
  • anorexia (+1)
  • fever (+1)
  • nausea or vomiting (+1)
  • tenderness over RIF (+2)
  • leukocytosis WCC >10 (+1)
  • left shift (+1)
  • migration of pain to RLQ (+1)
0-3 = appendicitis unlikely
4-6 = appendicitis considered 
7+ = appendicitis likely
19
Q

DKA in kids (definition)

A
  • BSL 11+
  • Ketones 0.6mmol/L + or 2+ (urine)
  • pH <7.25
  • Bicarbonate <15
20
Q

Complex febrile seizure criteria

A

Fever and ANY of

  • focal features at onset or during the seizure
  • duration >10 minutes
  • incomplete recovery within 1 hour
  • recurrence within the same febrile illness
  • age <6 months or >6 years
21
Q

HSP tetrad

A
  1. Purpura - most often present on areas of pressure or gravity dependent
  2. arthritis or arthralgia
  3. abdominal pain (can be complicated by intusussception)
  4. renal involvement - possible IgA nephropathy, nephrotic syndrome, HTN
22
Q

Red flag features of ataxia

A
altered conscious state
focal neurology
signs of raised ICP
meningism
posterior column loss
weakness
reduced reflexes