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My notes - med > Peds > Flashcards

Peds Flashcards

1
Q

Bronchiolitis

A

<1y, winter
bronchiole inflammation in response to recent viral illness
Usually RSV

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2
Q

Bronchiolitis sx

A 
Coryzal sx + fever precede:
dry cough
brethlessness
wheeze, fine inspiratory crackles
feeding difficulties + dyspnea
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3
Q

Bronchiolitis ED referral

A 
Apnea
Looks seriously unwell
Severe resp distress (grunting, chest recession, RR >70)
Central cyanosis
Persistent O2 <92 on air
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4
Q

Bronchiolitis consider admit if:

A

resp >60
Difficulty feeding, not taking oral fluids
Dehydration

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5
Q

Bronchiolitis mgmt

A

Supportibe
Humidified O2 via head box if <92%
NG feed
Suction if upper airway secretions

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6
Q

Whooping cough tx

A

Azithromycin or Clarithromycin/Erythromycin if cough onset within last 21d

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7
Q

Whooping cough prs:

A

2-3d coryza then:
coughing (worse at night + post feed, can end w vom/central cyanosis
Inspiratory whoop - not always
Apnea in infants
Persistent cough can cause subconjunctival hem or anoxia (syncope/seizures)
Sx 10-14 weeks
Lymphocytosis

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8
Q

Whooping dx criteria

A 
Cough >14d without apparent cause and has one+ ft:
Paroxysmal cough
Inspiratory whoop
Post-cough vom
Undx apnoeic attacks in infants
Back to school 48h post abx
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9
Q

Patent ductus arteriosus

A

Acyanotic (can be cyanotic later)
Cnx: pulm trunk and descending aorta
Closes w first breath usually from increased pulm flow–>more prostagalndin clearance
Common in premature, high altitude, maternal rubella in 1st tri

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10
Q

Patent ductus arteriosus defn

A

Opening between pulm trunk and aorta doesnt close

Allows O2 blood from aorta/LH to flow back into lungs

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11
Q

Patent ductus arteriosus ft

A 
left subclavian thrill
Continuous machinery murmur
Large vol, bouding, collapsing pulse
Wide pulse pressure
Heaving apex beat
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12
Q

Patent ductus arteriosus mgmt

A

Indomethacin/Ibuprophen - to neonate, stops PG synthesis, closes connection

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13
Q

Low set ears, microgrnathia, rocker bottom feet, orverlapping fingers

A

Edwards (18)

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14
Q

Microcepahly, small eyes, cleft lip/palate, poludactyly, scalp lesions

A

Patau (13)

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15
Q

Learning diff, macrocephaly, long face, large ears, high arched palate, macro-orchidism, hypotonia, autism, mitral valve prolapse

A

Fragile X

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16
Q

Webbed neck, pectus excavatum, short, pulm stenosis

A

Noonan Syndrome

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17
Q

Micrognathia, posterior displacement of tongue, cleft palate

A

Pierre-Robin syndrome

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18
Q

Hypotonia, hypogonadism, obesity

A

Prader-Willi

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19
Q

Short, learning diff, friendly extrovert, transient neonate hyper-Ca, supravalvular AS

A

William’s

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20
Q

Characteristic cry (larynx + neuro problem), feeding poor, poor weight, learning diff, microceph, micrognathia, widely spaced eyes

A

Cri Du Chat (ch 5p deletion)

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21
Q

Wilm’s tumour assoc w

A

WAGR syndrome (Aniridia, GU malform, Mental R)
Hemihypertrophy
Beckwith-Wiedemann syn

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22
Q

Wilm’s tumour ft

A 
<5y (usually 3)
Abdo mass 
Painless hematuria
Flank pain
Anorexia/Fever
Unilateral
Mets in 20% (lung)
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23
Q

Wilm’s tumour mgmt

A

nephrectomy
chemo
radiotherapy if advanced
80% cure rate

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24
Q

Peds fluid bolus

A

20ml/kg over <10min

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25
Q

Maintenance fluid

A

100ml/kg first 10

50ml/kg next 10

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26
Q

Replacement fluid

A

100ml/kg if shocked

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27
Q

Clinical dehyd

A 
Unwell/deteriorating
Decreased urine output
Skin colour normal
Warm extremities
Altered mental (irritable, lethargic)
Sunken eyes
Dry mucous
Tachypnic
Tachycardic
Normal pulses
Normal cap refill
Reduced skin turgor
Normal BP
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28
Q

Clinical shock

A 
Decreased conscious
Cold extremities
Pale/mottled skin
Tachy Tachy
Weak periph pulses
Prolonged Cap
Hypotension
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29
Q

Hypernatremic dehydration

A 
jittery mvmt
increased muscle tone
hyperreflexia
convulsions
drowsy/coma
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30
Q

Rapid onset fever, stridor, drooling, tripod

A

acute epiglottitis

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31
Q

Most common cause of epiglottitis

A

Hemophilus influenza B

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32
Q

Most common cause tonsillitis

A

Adenovirus

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33
Q

Common cause of croup

A

parainfluenza virus

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34
Q

steeple sign xray

A

croup

subglottic narrowing

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35
Q

Epiglottitis mgmt

A 
Immediate senior
ET maybe
DONT examine throat
O2
IV abx
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36
Q

Mycoplasma pneumonia ABX

A

Macrolide: erythromycin, azithromyc, clarithro

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37
Q

Pneumonia (S. Pneumo) tx

A

1st: Amoxicillin

Add macrolide if no response

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38
Q

Pneumonia assoc w influenza tx

A

co-amox

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39
Q

lethargy, coryza + fever, slapped cheek spreads to proximal arms + extensor surfaces

A

Parvovirus B19 - erythema infectiosum

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40
Q

Fever then itchy rash on head/trunk then spreads. Macular then papular then vesicular. Systemic upset

A

Chickenpox

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41
Q

Prodrome: iritable, conjunctivitis, fever. Koplik spots. Rash: behind ears then to whole body, discrete maculopapular becoming blotchy

A

Measles

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42
Q

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral

A

Mumps

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43
Q

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

A

Rubella

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44
Q

Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

A

Scarlet Fever

Group A haemolytic streptococci

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45
Q

Mild systemic upset: sore throat, fever

Vesicles in the mouth and on the palms and soles of the feet

A

coxsackie A16 virus

Hand foot mouth

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46
Q

Dermoid cyst

A

site of emryonic debelopmental fusion
Midline of neck, external eye corner, posterior pinna od ear
Hair follicles etc

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47
Q

Epidermoid cyst

A

contain keratin plug

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48
Q

Sebasceous cyst

A

punctum, contain cheesy material

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49
Q

Keratocanthoma

A

skin lesion in sun damaged skin, grows for months

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50
Q

Caput succadeneum

A 
Immediately after/at birth, due to generalized superficial scalp edema
Crosses suture lines
At vertex
Prolonged labour
Resolves in days
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51
Q

Subaponeurotic hematoma

A

Bleeding not bound by periosteum

Life threatening, presents w fluctuant scalp selling not limited y sutures

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52
Q

Craniosynostosis

A

Premature closure of cranial sutures causing deformity
Genetic or birth
Early closure of ant. font. and raised ridge along fused suture

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53
Q

Cephalohematoma

A

Swelling from bleeding between periosteum + skull
Usually parietal region after assisted deliv
Shows up 2-3 days post birth
Does not cross sutures
Resolves over weeks/months
Can have jaundice

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54
Q

ADHD criteria inattention

A 
6 in under 16, 5 in over
Doesnt follow through in instructions
Reluctant to engage in mentally intense tasks
Easily distracted
Difficult to  sustain tasks
Hard to organize tasks/activities
Forgetful in daily activities
Loses things needed for tasks
Doesnt seem to listen when spoken to directly
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55
Q

ADHD criteria hyper/impulsive

A 
6 in under 16, 5 in over
Unable to play quietly
Talks excessively
Doesnt wait turn well
Spontaneously leaves seat
On the go
Interruptive/intrusive
Answer before question finished
Run/climb when not appropriate
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56
Q

ADHD mgmt

A 
10w watch and wait
Parents education/training
Pharm >5y
1st: Methylphenidate 6w trial
2nd: Lisdexamfetamine if cant tolerate it go to Dexamfetamine
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57
Q

Methylphenidate

A

CNS stimulant, acts as dopamine/norepinephrine reuptake inhibitor
SE: GI, dyspepsia
Monitor weight gain 6 monthly
Cardiotoxic - baseline ECG

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58
Q

Turners murmur

A

ejection systolic: bicuspid aortic valve–> AS

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59
Q

Mitral stenosis murmur

A

mid diastolic murmur

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60
Q

Turners syndrome ft

A

short stature
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
primary amenorrhoea
cystic hygroma (often diagnosed prenatally)
high-arched palate
short fourth metacarpal
multiple pigmented naevi
lymphoedema in neonates (especially feet)
gonadotrophin levels will be elevated
hypothyroidism is much more common in Turner’s
horseshoe kidney

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61
Q

Croup mgmt

A

Single dose dexamethasone (prednisolone if not)

Emerg: high flow O2 + nebulised adrenaline

62
Q

Whooping cough comps

A

Subconjunctival hem
Pneumonia
bronchiectasis
seizures

63
Q

Causes of constipation

A 
Dehydration
Low fibre
Meds - opiates
Anal fissure
Over enthusiastic potty training
Hypothyroid
Hirschsprungs
Hypercalcemia
Leaning disab
64
Q

Stool red flags

A 
From birth of first few weeks
meconium >48h
Ribbon stool
Faltering growth
Weakness in legs/locomotor delay
Distension
65
Q

Fecal impaction sx

A

severe constip
overflow soiling
fecal mass palpable in abdo

66
Q

Fecal impaction mgmt

A

polyethylene glycol 3350 + electrolytes (movicol peds)
add stimulant laxative if no change >2w
Add/sub in osmotic laxative (lactulose) if movicol not tolerated

67
Q

Kallman syndrome

A

boy w late puberty and impaired smell
Xlinked recessive
Hypogonadism, cryptochidism, anosmia, low sex hormones, LH/FSH low, tall
Cleft lip/palate, visual/hearing defects

68
Q

Girl w Primary amenorrhea, masses in groin

A

Androgen insensitivity syndrome

69
Q

Precoscious puberty, early hair, girls w ambiguous genetalia + virilisation

A

Congenital adrenal hyperplasia

70
Q

LH low

Test Low

A

Hypogonadotrophic hypogonadism (Kallman)

71
Q

LH high

Test Low

A

Primary hypogonadism (Klinefelters)

72
Q

LH High

Test norm/high

A

androgen insensitivity syndrome

73
Q

LH Low

Test High

A

testosterone secreting tumour

74
Q

Tall, lack 2ndary sexual char, small/firm testes, infertile, gynecomastia, high gonadotropins, 47 XXY

A

Klinefelters

75
Q

Klinefelters

A

Tall, lack 2ndary sexual char, small/firm testes, infertile, gynecomastia, high gonadotropins, 47 XXY

76
Q

boy w late puberty and impaired smell
Xlinked recessive
Hypogonadism, cryptochidism, anosmia, low sex hormones, LH/FSH low, tall
Cleft lip/palate, visual/hearing defects

A

Kallman

77
Q

Androgen insensitivity syndrome

A

X ,inked recessive
End organ resistance to testosterone - genetically male w female phenotype
Primary amen, undscended testes, breast development
46XY

78
Q

Androgen insensitivity syndrome tx

A

Counsel - raise as girl
bilateral orchidectomy
estrogen therapy

79
Q

Heel prick

A 
day 3-5
Congenital hypotheyroid (CHT)
CF
Phenylketonuria (PKU)
Medium chain acyl-coA dehydrogeniase deficiency (MCADD)
Glutaric aciduria T1
Homocystinuria (HCU)
Maple syrup urine disease (MSUD)
Classical galactosemia (C Gal)
80
Q

Neonatal sepsis cause

A

First 28d of life
GBS, E Coli - early onset
Staph epi, Pseudo arginosa, kleps, enterobacter, Candida albicans - late onset (after 72h)

81
Q

Neonatal sepsis RF

A

Prev baby w GBS/current GBS/bacteruria, high temp >32, >18h membrane ruprute, current infection throughout preg
Premature <37w
Low birth weight <2.5kg
Maternal chorioamnionitis

82
Q

Neonatal sepsis sx

A 
Resp distress (grunting, nasal flaring, access muscles, tachyp)
Tachycardia
Apnea
Lethargy
Jaundice
Seizures
Poor feeding
Ando distension
Vome
Temp high or low
83
Q

Neonatal sepsis Ix

A 
Blood culture
FBC ( high/low neutrophils,)
CRP
Blood gases (met ac)
Urine MCS
LP - if meningitis concern
84
Q

Neonatal sepsis mgmt

A

Early ID
IV benzylpenicillin + gent - measure CRP 18-24 after, can stop if CRP <10 @ 48h, if not 10d
Maintain O2, fluids, sugars, watch for met acidosis

85
Q

Hand foot mouth sx

A

sore throat, fever
oral ulcers
vesicles on palms + soles

86
Q

Hand foot mouth tx

A

hydration, analgesia
reassurance
Keep out of school if they dont feel well

87
Q

Chest compression rate for kids

A

100-120/min

chest to breath 15:2

88
Q

Intussusception Ix

A

US - target like mass

89
Q

Red current jelly stools

A

Intussusception

90
Q

Intussusception sx

A 
Paroxysmal abdo colic pain
During pain - draw knees up and become pale
Vom
Red currant jelly stool
Sausage shaped mass in RUQ
91
Q

Intussusception mgmt

A

Reduction by air insufflation under radiology

If peritonitic - surg

92
Q

Downs ft

A
  • upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
  • flat occiput
  • single palmar crease, pronounced ‘sandal gap’ between big and first toe
  • hypotonia
  • congenital heart defects (40-50%, see below)
  • duodenal atresia
  • Hirschsprung’s disease
93
Q

Downs heart conditions

A 
atrioventricular septal defect
ventricular septal defect
secundum atrial septal defect
tetralogy of fallot
patent ducus arteriosus
94
Q

Downs later comps

A 
subfertility (males always, females sub)
Learning diff
Short
Resp infx
Hearing impair (glue ear(
ALL
Hypothyroid
Alzheimers
Atlantoaxial instability
95
Q

CF presentation

A

neonate: meconium ileus prolonged jaundice, recurrent chest infx
malabsorption: steatorrhea, failure to thrive
Other: liver disease
Pancreatic insufficiency–>steatorrhea from malabsorption of fats

96
Q

CF features

A 
short
DM
delayed puberty
rectal prolapse
nasal polyps
male infert, female sub
97
Q

Biliary atresia

A

obliteration or discontinuity withing extrahepatic biliary system –> obstructed flow of bile
Cholestasis in first weeks (pale stool + dark urine)

98
Q

Biliary atresia presentation

A 
First few weeks of life:
Jaundice beyong 2 weeks
Dark urine/pale stools
Appetitie + growth disturbance
Signs: jaundice, hepatomegaly + splenomegaly, abnormal growth, cardiac murmurs
99
Q

Biliary atresia Ix

A

Serum bili - conjugated is high
LFTs: usually high
Serum alpha 1 anti: deficiency can cause cholestasis
Sweat chloride: CF can affect biliary
US biliary tree +liver: distension + tract abnormalities
Percutaneous liver biopsy

100
Q

Biliary atresia mgmt

A

Surgical: Kasai

Need IV abx after and bile acid enhancers (ursodeoxycholic acid)

101
Q

Necrotising enterocolitis

A 
Premature
Feeding intolerance
Abdo distension
Bloody stools
XRay: dilated loops, bowel wall edema, pneumatosis intestinalis, portal venous gas, penumoperitoneum from perf, air on both sides (Rigler), air outlining falciform lig (football sign)
102
Q

Meningitis under 3mo Tx

A

cefotaxime + IV amox (covers listeria)

103
Q

Meningitis peds Ix

A

Septicemia - LP
DONT do LP if:
focal neuro signs, papilledema, bulging fontanelle, DIC, cerebral herniation AKA any signs of raised ICP

104
Q

Meningitis over 3mo

A

IV cefotaxime
dexamethasone if LP shows purulent CSF, high WBC CSF, high WBC + protein CSF, bacteria on gram stain
Fluids - colloid
Cerebral monitoring
Public health notification (cipro for prophylaxis)

105
Q

X-linked recessive heritance pattern

A

all female offspring of affected man will carry, sons ill not have
These females have 50% chance passing it on to male, and 50% daughters will carry

106
Q

X linked recessive affects:

A

males only will be affected

107
Q

2 month vaccines

A

rotavirus
6 in 1
PCV
Men B

108
Q

6 in 1 vaccine

A

Diptheria, Hem Influenza B, Hep B, Pertussis, Polio, Tetanus

109
Q

4 in 1 vaccine

A

tetanus, diptheria, pertussis, polio

110
Q

4 month vaccines

A

Rotavirus
6 in 1
Men B

111
Q

6 month vaccines

A

6 in 1
PCV
MenC

112
Q

12 month vaccines

A

MMR

MenB

113
Q

13 month vaccines

A

Hib/MenC

PCV

114
Q

4-5 year vaccines

A

4 in 1

MMR

115
Q

12-13y vaccine

A

MenC
Tdap
HPV x 2

116
Q

65y older vaccines

A

Flu

Pneumococcal

117
Q

Rotavirus vaccine

A

2, 4 mo

118
Q

6 in 1 vaccine

A

2, 4, 6 mo

119
Q

Meningitis vaccines

A

2, 4, 12, 13 mo

120
Q

PCV vaccine

A

2, 6, 13 mo

121
Q

MMR vaccine

A

1, 4/5

122
Q

3 month speech/hearing

A

turns to sound, squeals

123
Q

6month speech

A

double sylable babble

124
Q

9mo speech

A

mama/dada, understands no

125
Q

12 mo speech

A

knows and responds to own name

126
Q

12-15mo speech

A

2-6 words, understands simple commands “give it to mummy”

127
Q

2y speech

A

combines 2 words, points to body parts

128
Q

2.5y speech

A

200 word vocab

129
Q

3y speech

A

short sentences, what and who questions, knows colours, counts to 10

130
Q

4y speech

A

why/when/how questions

131
Q

UTI presentation

A

infant: poor feed, vom, irritable
Young child: abdo pain, fever, dysuria
Older child: dysuria, frequency, hematuria
Upper UTI: >38, loin pain/tender

132
Q

UTI mgmt

A

<3mo: immediate referral to peds
<3mo upper UTI: hospital admission, oral ABX (cephalosporin, co-amox) 7-10d
>3mo lower UTI: oral abx 3 d (trimethoprim, nitrofurantoin, cephalosporin, amox)
Abx prophylaxis not given unless recurrent

133
Q

Mebendazole

A

worms, give to everyone

134
Q

Threadworm sx

A

perianal itching worse in PM, girls w vulval sx

Small threads of white cotton around anus or in poop, can move

135
Q

Threadworm tx

A

Mebendazole 1 dose for whole family

Hygiene measures

136
Q

Tx for danger of hypoxic brain injury

A

therapeutic cooling to 33-35 degrees

137
Q

Uses of therapeutic cooling

A
  • neonates w moderate to severe hypoxic ischemic encephalopathy
  • neuroprotection during open heart + neuro surgeries
  • following return of spontaneous circulation post v-fib arresr
  • trauma head injuries
  • acute ischemic stroke
138
Q

Hypoxic perinatal brain injury

A

decrease in O2 to infants brain just prior to, or during labour
Can develop HIE

139
Q

Criteria for therapeutic cooling neonates

A

GA >36w and weight >1800g
Hx acute perinatal event during delivery assoc w hypoxia and/or APGAR <5 @10m, or 10m PPV
Severe met acidosis on cord gas or blood gas w/in 1h
Severe/moderate HIE

140
Q

Severe/moderate HIE ft

A

seizures, and/or on the basis of clinical assessment of consciousness level, spontaneous activity, posture, tone, primitive reflexes, and autonomic systems.

141
Q

Therpeutic cooling

A

Start within 6hr of insult, continue for 72h
33-34 degrees for body
34-35 for head cooling
Rewarm @ .5 degree/hr x 6-12h

142
Q

Turner

A

45XO

143
Q

Prader Willi

A

Ch 15 loss of arm

Inherited from dad

144
Q

CAH bloods

A

low aldosterone
low cortisol
high testosterone

hyponatremia
hyperkalemia
hypoglycemia

145
Q

Primary Addisons/Adrenal insufficiency bloods

A

Low cortisol
High ACTH
Low aldosterone
High renin

hyponatremia
hyperkalemia
hypoglycemia

146
Q

Seoncdary addisons/adrenal insufficiency bloods

A

Low cortisol
Low acth
normal aldosterone
normal renin

hyponatremia
hyperkalemia
hypoglycemia

147
Q

Glucocorticoid replacement

A

Hydrocortisone

148
Q

Aldosterone replacement

A

Fludrocortisone

149
Q

Addisonnian crisis

A 
reduced consciousness
HYPOtension
HYPOglycemia
HYPOnatramia
HYPERkalemia
150
Q

DKA bloods

A

Hyperglycemia (>11)
Ketosis (>3)
Acidosis (<7.3)

151
Q

DKA mgmt

A

IV fluids
Get K above 3.3 (KCl)
Fixed rate insulin infusion
Glucose once <14 - prevent hypo

My notes - med (14 decks)

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