Peadiatrics Lectures Flashcards
When do you give prednisolone is childhood asthma?
The use of oral corticosteroids should be limited to children with severe wheeze who require hospital admission. The initial dose is 2mg/kg (max 60mg), followed by daily doses of 1mg/kg for 3 days. A prolonged course may be indicated in severe cases.
What is an asthma reducing medication plan?
An asthma reducing medication plan is a 3-5 day plan that a child is sent home from hospital on to reduce their medications from an acute asthma attack. The child is then meant to see their GP on day three for a medications review and assessment. If a child is <20 kegs they are given 6 puffs(600mcg) every4 hours, if they are over >29kgs they are given 12 puffs(1200 mcgs) every 4 hours. Eg. <20 kg child day one:6 puffs q4h, day two: 4-6 puffs q6h, day three 2-4 puffs q8h.
>20kg child day 1: 12 puffs q4h, day 2 8-12 puffs q6h, day three 4-8 puffs q 8h. The plan also includes and preventer meds and prednisolone.
How do you manage mild asthma?
Mild asthma has O2 sats>94%, child is alert, can talk in sentences, no cyanosis, no acessory muscle use. Give salbutamol stat(<20kgs 6 puffs, >20kgs 12 puffs). 3 hourly observations.
How do you treat moderate asthma?
Moderate asthma pus as a child who is easily engaged, talks in phrases, has a 02 sat of 90-94%, and has no cyanosis. They should be give oxygen and should aim for it to be >94%. They should be give stat salbutamol (6or 12 puffs ) 3 times 20 minutes apart, and then repeat as required. Consider Ipratropium (atroventmuscarinic acetylcholine inhibitor) 20 minutely with salbutamol, give oral prednisolone, give continuous observations for 3 hours then admit or discharge.
How do you treat severe asthma?
Severe asthma presents with altered consciousness (agitated drowsy), quiet wheeze, O2 sats <90, talks in words, weak cry, or silent, and may have cyanosis. Give oxygen (possibly high flow), give salbutamol and Ipratropium 3 times 20 minutes apart . Give hydrocortisone or methylprednisone, have continous monitoring, consider ABGs, CXR, and UEC. If poor response give IV salbutamol for 1 hour. Consider transfer to PICU.
What is the criteria for discharge from an asthma attack?
Patient must be weaned off IV salbutamol and oxygen and must not be taking salbutamol every three hours. Stretch asthma medication and discharge with an asthma medication reducing plan and instructions to see GP on third day. Review asthma action plan. Give parents any discharge medications and the children’s asthma resource pack for parents and careers.
What are the different patterns of asthma?
Infrequent intermittent, frequent intermittent, and persistent (mild, moderate, or severe).
What preventer therapy would you give to children with frequent intermittent or persistent asthma?
Give monteleukast or a low dose inhaled cortico steroid. If needed increase dose of corticosteroid. Consider adding a long acting beta antagonist or monteleukast. If needed, increased inhaled corticosteroid dose to as high as possible.
What is flixotide?
Flixotide is fluticasone. Fluticasone is an inhaled corticosteroid that is used once a day. It comes in an inhaler, nebuliser, and accuhaler.
What is pulmicort?
Pulmicort is budesonide which is a corticosteroid, it is taken once a day as a preventer. It can be taken via a nebuliser or a turbuhaler.
What is Qvar?
Qvar is beclomethasone is a steroid medication that should be taken once a day.it can be taken via automaker or puffer.
What is seretide?
Seretide is fluticasone (a corticosteroid) and salmeterol (long acting beta agonist).
What is symbicort?
Symbicort is budesonide (a corticosteroid) and eformaterol (long acting beta 2 agonist)
What is singular?
Singuliar is monteleukast. Monteleukast is a leukotriene receptor antagonist.
What is alvesco?
Alvesco is ciclesonide. It is a glucocorticoid that is taken twice daily and is used to treat asthma.
What is omalizumab?
Omalizumab is an anti IgE antibody that binds to an area of C3 of free IgE. It attenuates the early and late phase responses to inhaled allergen challenge. It is given in fortnightly to monthly injections and people over 12 years. Has a high rate of anaphylaxis and is expensive. Used in steroid dependent asthma.
What is the acceptability and repeatability requirement for spirometer?
Good start
Acceptable exhalation (>3 seconds for <10, >6 seconds for >10)
Must have three acceptable manoeuvres
Two largest FVC and FEV1 measurements within 150 mLs of each other.
How do you calculate reversibility after a beta agonist in spirometry?
100x FEV1 post meds- FEV1 baseline / FEV1 baseline
What sort of pattern in spirometry presents with decreased FEV1, FVC (may also be normal), and decreased FEV1/FVC?
Obstructive (asthma)
What presents with a decreased FEV1, FVC, but a normal or increased FEV1/FVC?
Restrictive eg. Scoliosis.
What is a normal sleep pattern for a 0-3 month child?
95% sleep during the day every day. Take half hour to an hour to settle, may wake up six times during the night, but most commonly twice.
What is a normal sleeping pattern for a 1 year old?
90% have a daytime nap for 1-2 hours, most settle between 6 and 8 pm, 80% settle quickly, 10% wake more than 3 times a night.
What is a normal sleeping pattern for a 2 year old?
Half still have daytime naps, they may sleep after 8pm, half still wake once during the night requiring parents attention.
When does reflux in a child become pathological?
When there is poor growth
If a baby’s vomit is blood stained ( this may indicate oesophagitis)
Rarely if causes breathing difficulties, chest infections, or apnoea
Crying and irritability uncommonly caused by reflux
How do you treat reflux in infants?
No treatment required for most children.
Thickened feeds
Positioning (poor evidence)
Meta loperamide (not worth harm for benefit)
PPI or H2 antagonist if suspected oesophagitis
Fundoplication if severe
What characterises lactose intolerance?
Abdo pain, diarrhoea, nausea, flatulence, bloating
What is developmental lactase deficiency?
Developmental lactase deficiency occurs in babies <34 weeks old
What is congenital lactase deficiency?
Congenital lactase deficiency is a very rare disorder that occurs when a child would not survive without lactose free human milk substitute.
What is primary lactase deficiency?
Primary lactase deficiency is a relative or absolute absence of lactase that develops in childhood and is uncommon in children < 2 years of age. It is the most common cause of lactose deficiency and is more common in some ethnic groups (Asian and Hispanic)
What is secondary lactase deficiency?
Secondary lactase deficiency results from small bowel injury eg.gastro, bacterial, chemo
What test can be used to diagnose a lactose intolerance?
A hydrogen breath test can be used to diagnose subtle lactose intolerance. However, normally it is Dx by eliminating
Lactose from the diet and then returning it and watching the correlating pattern in the symptoms.
How do you manage frothy stools in a breast fed infant?
Frothy stools are caused by a relative lactose malabsorption. They can be due to an oversupply - advise to feed fully from one breast only for a few feeds.
What is the expected weight gain in an infant?
The expected weight gain is 100-200 grams per week
What is positional plagiocephaly?
Positional plagiocephaly is when a baby gets a flat head from lying on it too much. There is posterior skull flattening with a n ipsilateral bulge. Benign condition. However, must exclude craniosynotosis (premature fusion of one or more cranial sutures). Also check for torticollis
When does the foramen ovale close?
The foramen ovale closes at birth. This results in a combination of increased left atrial pressure secondary to increases in pulmonary blood flow and pulmonary venous return, and from decreases in right atrial pressure secondary to decreases in blood returning to heart from inferior vena cava after placental circulation is removed.
When does the ductus venosus close and what makes it close?
The ductus venosus closes shortly after birth due to the cessation of umbilical venous return. There is complete closure 3-7 days after birth.
What are the acquired peadiatric heart diseases?
Rheumatic fever (acute and chronic), Kawasaki disease, endocarditis, and some cardiomyopathies.
What is e most common type of congenital heart disease?
VSD, then ASD, then PDA
What are the different grades of murmurs?
Grade 1 : scarcely audible Grade 2: soft Grade 3: loud Grade 4: loud, faint thrill Grade 5: very loud, easily felt thrill Grade 6: heard without a stethoscope
What are the symptoms of an innocent murmur?
Asymptomatic, grade 1-3, changes with position, systolic ejection, musical vibratory
What are the symptoms on a pathological murmur?
Diastolic, or loud systolic murmur that has a thrill or radiates to other parts, cyanosis, abnormally strong or weak pulses, abnormal heart sounds eg. Clicks, abnormal CXR, abnormal ECG
What is a stills murmur?
Stills murmur is an innocent vibratory, musical systolic ejection murmur that is heard in the tricuspid or aortic areas. It is made louder by lying in the supine position, gets worse with illness, and disappears by puberty.
What are the innocent heart murmurs?
Stills murmur,
Carotid bruit,
Venous hum
Pulmonary flow murmur
Way is a pulmonary flow murmur?
Also know as a right ventricular outflow murmur, a pulmonary flow murmur is an innocent systolic ejection murmur heard in the pulmonary area.
What is a normal finding on ECGs in newborns?
It is normal to have right axis deviation and right ventricular dominance in newborns.
What are the causes of a cyanotic heart disease?
Left to right shunt: VSD, ASD, PDA,
Obstructive heart disease: aortic stenosis, pulmonary stenosis, aortic coarctation
What causes cyanotic heart disease?
Right to left shunt:
Tetralogy of fallot, Transposition of the great arteries, truncus arteriosus, tricuspid atresia, total anomalous pulmonary venous connection, Ebstein’s anomaly, or a single ventricle.
What changes are seen on X-ray in an ASD? What murmur would you hear?
-increase in the right pulmonary vasculature
- Very enlarged right atrium
-moderately enlarged right ventricle and left ventricle.
Cardiomagaly with an advancement of the right cardiac border.
It causes a pulmonary systolic ejection murmur with fixed splitting of the second heart sounds.
What changes on x ray indicate a VSD? What murmur can be heard?
There is:
-increased right pulmonary artery vasculature
-increased size of the left atria and left ventricle
-movement of the cardiac border downward and to the left.
It produces a holosyatolic murmur.
Where does eczema tend to occur? What are its typical features?
Occurs in flexor surfaces, cradle cap, neck, hands, breasts, . Produces exforiation, redness, oedema, itching, dryness, crusting, flaking, blistering, cracking, oozing or bleeding. Worse with change in weather, sickness and immunisation, skin dryness. Avoid any irritants.
For baby’s with bad eczema:
Moisturise 3 times a day
Use a strong topical corticosteroid 3 times a day
Wet dressings may also be used.
What is the most characteristic mark of Tinea?
An annular ring.
What are the identifying characteristics of a herpes skin infection?
Painful, blistering, well demarcated scalloped edge. Peri oral. If a neonate has HSV it is an emergency.
What is the pathogenisis of impetigo?
Impetigo is caused by staph aureus, and also rarely by group A beta heamolytic streptococci. The strains release a toxin that splits the epidermis at the level of the stratum corneum. The split then results in blister formation.
What causes most cases of folliculitis in children?
Staph aureus, dermatophytes (Tinea), or pseudomonas aueroginosa
What is a vesicle? What are the vesicular rashes?
A vesicle is fluid filled and normally less than 0.5 cm in diameter. Causes of vesicular rashes include:
- varicella zoster
- herpes simplex
- hand foot mouth disease
- molluscum contagiousum
- dermitis heroatiformis
- steven Johnsons syndrome
What is the incubation period of chicken pox? When does a person first become infectious? How does it present?
Chicken pox has an incubation period of 10 - 21 days. People become infectious 48 hours prior to onset of the rash until the less crust. It presents with vesicular lesions at different stages, with a predominantly truncal distribution, present in the hair line, and with posterior cervical adenoma thy, and fever at the onset of illness.
What is a macular papular rash? What causes maculopapular rashes?
A macula is a small flat impalpable lesion, while a papular is a raised circumscribed lesion. Causes of maculopapular rashes include: Measles Rubella Scarlet fever Kawasakis disease Erythema infectiousum Roseola infantum Other viral infections
