Paeds VIVAs Flashcards
What are the risks associated with DKA?
Cerebral oedema
Hypokalaemia
Aspiration pneumonia (due to NG tube)
What are the long term complications with T1DM?
Macrovascular:
- CHD
- HTN (annual monitoring from 12)
Microvascular:
- Peripheral neuropathy
- Kidney disease + Retinopathy (annual monitoring from 12)
Infection related:
- Increased risk of UTI, pneumonia (give influenze + pneumococcal vaccines yearly), candida
Why does T1DM lead to increased risk of infections?
Hyperglycaemia → immunosuppresion + creates an optimal environment for infectious organisms to thrive
Estimation of dehydration in DKA?
Mild 5% = 7.2 - 7.29
Moderate 7% = 7.1 - 7.19
Fluid deficit volume = % deficit x weight (kg) x 10 over 48 hours
If non-shocked: Fluid deficit volume - 10ml/kg bolus = final rehydration fluid volume over 48 hours
What is McBurneys point ad where is it?
This is the place the abdominal pain classically localises to in appendicitis
It is found 1/3 the distance from theanterior superior iliac spine(ASIS) to theumbilicus
What are the main causes of appendicitis?
Infection secondary to obstruction of the lumen of the appendix
The main causes of obstruction are faecolith, normal stool, lymphoid hyperplasia
Obstruction leads to increased intraluminal pressure and bacterial overgrowth, ischaemia, and necrosis of the appendix
What is the most common type of intussusception?
ileo-colic
What is the most common cause of intestinal obstuction in infants after neonatal period?
Intussusception
What are some conditions associated w intussusception?
HSP
CF
Lymphoma
Lymph nodes
What are the compications of intussusception?
Stretching and constriction of the mesentery resulting in venous obstruction → causing engorgement and bleeding from the bowel mucosa → fluid loss → eventually bowel perforation, peritonitis and gut necrosis
venous obstruction, engorgement, perforation, peritonitis, bowel ischaemia
What complications are associated w tonsilitis?
Quinsy: peritonsillar abscess, requires drainage and IV antibiotics
Retropharyngeal abscess
Acute glomerulonephritis
Rarely can cause toxic shock syndrome mediated by S. Aureus superantigens – which requires escalation to PICU, fluid resus and IV/IO Clindamycin (ceftriaxone if suspected sepsis)
Complications associated w epilepsy?
ALL AEDs have potential adverse effects related to them, sudden unexplained death in epilepsy, injuries during seizures, absence from school which can contribute to increased risk of depression and anxiety disorders in these children
What is the most common type of epilepsy in children?
Most common type in children: benign rolandic epilepsy
Can occur at night with tonic-clonic seizures during sleep
What is the prognosis for children with epilepsy?
- ~ 70% of children with epilepsy will be in remission
- Children with epilepsy do less well educationally, with social outcomes and future employment compared to others with chronic conditions e.g. diabetes
- 2/3 of children go to mainstream school but some may need educational help for associated learning difficulties
- 1/3 go to special schools but often have multiple disabilities and their epilepsy is part of a severe brain disorder.
- Few children require residential schooling
What is West syndrome?
Rare (1/4000) form of childhood epilepsy typically presenting in 1st 4-8 months of life which is more common in males and often is associated with an underlying condition and poor prognosis
Key features of west syndrome?
Salaam attacks (flexion of head trunk and arms + extension of arms) – 1-2s long but can repeat upto 50 times
Different to colic as in West’s children as distressed and cry between spasms whereas in colic child is distressed during ‘spasm’
Can cause developmental issues and progressive mental handicap
Prognosis of West Syndrome?
- Poor prognosis
- 1/3 die by age 25
- however 1/3 are seizure free
- Gradual developmental decline w/ progressive mental handicap
How to quantify severity of acute asthma?
- Moderate: PEFR 50-75%, sats >92%, normal speech, some IC recession
- Severe: PEFR 33-50%, sats <92%, unable to complete sentences / too breathless to eat, accessory neck muscle use, tachycardia, tachypnoea
- Life-threatening: PEFR <33%, sats <92%, silent chest, poor resp effort, cyanosis, hypotension, arrhythmia, exhaustion, altered consciousness CHEST 92, 33
Complications of whooping cough?
- Bronchiectasis
- Pneumonia
Prognosis of whooping cough?
Vaccinated + not had it in the past –> Cough can last 3+ months
Milder symptoms in vaccinated + shorter lived in previously infected
What complications are associated w bronchiolitis?
Bronchiolitis obliterans (permanent damage to airways – usually seen w/ adenovirus), recurrent apnoea
Compliactions of Coeliac?
- Faltering growth, delayed puberty, Vit Deficiencies
- Anaemia, osteoporosis
- UC
- Malignancy – EATL
Prognosis for patients with Coeliac?
Rapid improvement following initiation of GF diet + restore bone mass after 6-12m of GF diet
What are some causes of meconium not being passed in the first 48 hours?
Cystic fibrosis
Hirschsprung disease
What are some interventions that may be used if medical evacuation is not possible?
Enemas
Manual evacuation under anaesthetic
How would your management be different if this patient was < 3 months old?
Admit straight away and seek senior advice
What are the most common organisms that cause UTIs in children?
E. coli
Klebsiella
Proteus
Name and describe a structural anomaly that increases a child’s risk of getting UTIs
Vesicoureteric reflux – the ureters insert directly into the bladder meaning that they have a short intramural path such that a full bladder no longer closes of the ureters.
This leads to reflux of urine up the ureters and, potentially, into the kidneys.
Posterior urethral valve – an obstructing membrane in the posterior male urethra that causes bladder outflow obstruction in male newborns
What does a DMSA scan do?
Detects renal scarring
What are the paediatric sepsis 6?
Give high flow oxygen
Obtain IV/IO access and take blood cultures (and blood gas, lactate and glucose)
Give IV/IO antibiotics
Consider fluid resuscitation
Involve senior clinicians early
Consider inotropic support early
Which organisms most commonly cause bacterial meningitis in this age group (10y)?
Neisseria meningitidis
Haemophilus influenzae
Streptococcus pneumoniae
What about in neonates? How would this affect the treatment?
Group B Streptococcus
Listeria monocytogenes
E. coli and other coliforms
Amoxicillin is also given along with a 3rd generation cephalosporin
List some contraindications for lumbar puncture.
Signs of raised ICP (e.g. coma, papilloedema, Cushing’s reflex (high BP, low HR))
Coagulopathy
Local infection at the site of LP
Meningococcal septicaemia
