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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
Maintenance fluid
100ml/kg first 10 | 50ml/kg next 10
26
Replacement fluid
100ml/kg if shocked
27
Clinical dehyd
``` 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 ```
28
Clinical shock
``` Decreased conscious Cold extremities Pale/mottled skin Tachy Tachy Weak periph pulses Prolonged Cap Hypotension ```
29
Hypernatremic dehydration
``` jittery mvmt increased muscle tone hyperreflexia convulsions drowsy/coma ```
30
Rapid onset fever, stridor, drooling, tripod
acute epiglottitis
31
Most common cause of epiglottitis
Hemophilus influenza B
32
Most common cause tonsillitis
Adenovirus
33
Common cause of croup
parainfluenza virus
34
steeple sign xray
croup | subglottic narrowing
35
Epiglottitis mgmt
``` Immediate senior ET maybe DONT examine throat O2 IV abx ```
36
Mycoplasma pneumonia ABX
Macrolide: erythromycin, azithromyc, clarithro
37
Pneumonia (S. Pneumo) tx
1st: Amoxicillin | Add macrolide if no response
38
Pneumonia assoc w influenza tx
co-amox
39
lethargy, coryza + fever, slapped cheek spreads to proximal arms + extensor surfaces
Parvovirus B19 - erythema infectiosum
40
Fever then itchy rash on head/trunk then spreads. Macular then papular then vesicular. Systemic upset
Chickenpox
41
Prodrome: iritable, conjunctivitis, fever. Koplik spots. Rash: behind ears then to whole body, discrete maculopapular becoming blotchy
Measles
42
Fever, malaise, muscular pain | Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral
Mumps
43
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day Lymphadenopathy: suboccipital and postauricular
Rubella
44
Fever, malaise, tonsillitis 'Strawberry' tongue Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Scarlet Fever | Group A haemolytic streptococci
45
Mild systemic upset: sore throat, fever | Vesicles in the mouth and on the palms and soles of the feet
coxsackie A16 virus | Hand foot mouth
46
Dermoid cyst
site of emryonic debelopmental fusion Midline of neck, external eye corner, posterior pinna od ear Hair follicles etc
47
Epidermoid cyst
contain keratin plug
48
Sebasceous cyst
punctum, contain cheesy material
49
Keratocanthoma
skin lesion in sun damaged skin, grows for months
50
Caput succadeneum
``` Immediately after/at birth, due to generalized superficial scalp edema Crosses suture lines At vertex Prolonged labour Resolves in days ```
51
Subaponeurotic hematoma
Bleeding not bound by periosteum | Life threatening, presents w fluctuant scalp selling not limited y sutures
52
Craniosynostosis
Premature closure of cranial sutures causing deformity Genetic or birth Early closure of ant. font. and raised ridge along fused suture
53
Cephalohematoma
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
54
ADHD criteria inattention
``` 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 ```
55
ADHD criteria hyper/impulsive
``` 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 ```
56
ADHD mgmt
``` 10w watch and wait Parents education/training Pharm >5y 1st: Methylphenidate 6w trial 2nd: Lisdexamfetamine if cant tolerate it go to Dexamfetamine ```
57
Methylphenidate
CNS stimulant, acts as dopamine/norepinephrine reuptake inhibitor SE: GI, dyspepsia Monitor weight gain 6 monthly Cardiotoxic - baseline ECG
58
Turners murmur
ejection systolic: bicuspid aortic valve--> AS
59
Mitral stenosis murmur
mid diastolic murmur
60
Turners syndrome ft
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
61
Croup mgmt
Single dose dexamethasone (prednisolone if not) | Emerg: high flow O2 + nebulised adrenaline
62
Whooping cough comps
Subconjunctival hem Pneumonia bronchiectasis seizures
63
Causes of constipation
``` Dehydration Low fibre Meds - opiates Anal fissure Over enthusiastic potty training Hypothyroid Hirschsprungs Hypercalcemia Leaning disab ```
64
Stool red flags
``` From birth of first few weeks meconium >48h Ribbon stool Faltering growth Weakness in legs/locomotor delay Distension ```
65
Fecal impaction sx
severe constip overflow soiling fecal mass palpable in abdo
66
Fecal impaction mgmt
polyethylene glycol 3350 + electrolytes (movicol peds) add stimulant laxative if no change >2w Add/sub in osmotic laxative (lactulose) if movicol not tolerated
67
Kallman syndrome
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
Girl w Primary amenorrhea, masses in groin
Androgen insensitivity syndrome
69
Precoscious puberty, early hair, girls w ambiguous genetalia + virilisation
Congenital adrenal hyperplasia
70
LH low | Test Low
Hypogonadotrophic hypogonadism (Kallman)
71
LH high | Test Low
Primary hypogonadism (Klinefelters)
72
LH High | Test norm/high
androgen insensitivity syndrome
73
LH Low | Test High
testosterone secreting tumour
74
Tall, lack 2ndary sexual char, small/firm testes, infertile, gynecomastia, high gonadotropins, 47 XXY
Klinefelters
75
Klinefelters
Tall, lack 2ndary sexual char, small/firm testes, infertile, gynecomastia, high gonadotropins, 47 XXY
76
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
Kallman
77
Androgen insensitivity syndrome
X ,inked recessive End organ resistance to testosterone - genetically male w female phenotype Primary amen, undscended testes, breast development 46XY
78
Androgen insensitivity syndrome tx
Counsel - raise as girl bilateral orchidectomy estrogen therapy
79
Heel prick
``` 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
Neonatal sepsis cause
First 28d of life GBS, E Coli - early onset Staph epi, Pseudo arginosa, kleps, enterobacter, Candida albicans - late onset (after 72h)
81
Neonatal sepsis RF
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
Neonatal sepsis sx
``` Resp distress (grunting, nasal flaring, access muscles, tachyp) Tachycardia Apnea Lethargy Jaundice Seizures Poor feeding Ando distension Vome Temp high or low ```
83
Neonatal sepsis Ix
``` Blood culture FBC ( high/low neutrophils,) CRP Blood gases (met ac) Urine MCS LP - if meningitis concern ```
84
Neonatal sepsis mgmt
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
Hand foot mouth sx
sore throat, fever oral ulcers vesicles on palms + soles
86
Hand foot mouth tx
hydration, analgesia reassurance Keep out of school if they dont feel well
87
Chest compression rate for kids
100-120/min | chest to breath 15:2
88
Intussusception Ix
US - target like mass
89
Red current jelly stools
Intussusception
90
Intussusception sx
``` Paroxysmal abdo colic pain During pain - draw knees up and become pale Vom Red currant jelly stool Sausage shaped mass in RUQ ```
91
Intussusception mgmt
Reduction by air insufflation under radiology | If peritonitic - surg
92
Downs ft
- 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
Downs heart conditions
``` atrioventricular septal defect ventricular septal defect secundum atrial septal defect tetralogy of fallot patent ducus arteriosus ```
94
Downs later comps
``` subfertility (males always, females sub) Learning diff Short Resp infx Hearing impair (glue ear( ALL Hypothyroid Alzheimers Atlantoaxial instability ```
95
CF presentation
neonate: meconium ileus prolonged jaundice, recurrent chest infx malabsorption: steatorrhea, failure to thrive Other: liver disease Pancreatic insufficiency-->steatorrhea from malabsorption of fats
96
CF features
``` short DM delayed puberty rectal prolapse nasal polyps male infert, female sub ```
97
Biliary atresia
obliteration or discontinuity withing extrahepatic biliary system --> obstructed flow of bile Cholestasis in first weeks (pale stool + dark urine)
98
Biliary atresia presentation
``` 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
Biliary atresia Ix
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
Biliary atresia mgmt
Surgical: Kasai | Need IV abx after and bile acid enhancers (ursodeoxycholic acid)
101
Necrotising enterocolitis
``` 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
Meningitis under 3mo Tx
cefotaxime + IV amox (covers listeria)
103
Meningitis peds Ix
Septicemia - LP DONT do LP if: focal neuro signs, papilledema, bulging fontanelle, DIC, cerebral herniation AKA any signs of raised ICP
104
Meningitis over 3mo
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
X-linked recessive heritance pattern
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
X linked recessive affects:
males only will be affected
107
2 month vaccines
rotavirus 6 in 1 PCV Men B
108
6 in 1 vaccine
Diptheria, Hem Influenza B, Hep B, Pertussis, Polio, Tetanus
109
4 in 1 vaccine
tetanus, diptheria, pertussis, polio
110
4 month vaccines
Rotavirus 6 in 1 Men B
111
6 month vaccines
6 in 1 PCV MenC
112
12 month vaccines
MMR | MenB
113
13 month vaccines
Hib/MenC | PCV
114
4-5 year vaccines
4 in 1 | MMR
115
12-13y vaccine
MenC Tdap HPV x 2
116
65y older vaccines
Flu | Pneumococcal
117
Rotavirus vaccine
2, 4 mo
118
6 in 1 vaccine
2, 4, 6 mo
119
Meningitis vaccines
2, 4, 12, 13 mo
120
PCV vaccine
2, 6, 13 mo
121
MMR vaccine
1, 4/5
122
3 month speech/hearing
turns to sound, squeals
123
6month speech
double sylable babble
124
9mo speech
mama/dada, understands no
125
12 mo speech
knows and responds to own name
126
12-15mo speech
2-6 words, understands simple commands "give it to mummy"
127
2y speech
combines 2 words, points to body parts
128
2.5y speech
200 word vocab
129
3y speech
short sentences, what and who questions, knows colours, counts to 10
130
4y speech
why/when/how questions
131
UTI presentation
infant: poor feed, vom, irritable Young child: abdo pain, fever, dysuria Older child: dysuria, frequency, hematuria Upper UTI: >38, loin pain/tender
132
UTI mgmt
<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
Mebendazole
worms, give to everyone
134
Threadworm sx
perianal itching worse in PM, girls w vulval sx | Small threads of white cotton around anus or in poop, can move
135
Threadworm tx
Mebendazole 1 dose for whole family | Hygiene measures
136
Tx for danger of hypoxic brain injury
therapeutic cooling to 33-35 degrees
137
Uses of therapeutic cooling
- 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
Hypoxic perinatal brain injury
decrease in O2 to infants brain just prior to, or during labour Can develop HIE
139
Criteria for therapeutic cooling neonates
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
Severe/moderate HIE ft
seizures, and/or on the basis of clinical assessment of consciousness level, spontaneous activity, posture, tone, primitive reflexes, and autonomic systems.
141
Therpeutic cooling
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
Turner
45XO
143
Prader Willi
Ch 15 loss of arm | Inherited from dad
144
CAH bloods
low aldosterone low cortisol high testosterone hyponatremia hyperkalemia hypoglycemia
145
Primary Addisons/Adrenal insufficiency bloods
Low cortisol High ACTH Low aldosterone High renin hyponatremia hyperkalemia hypoglycemia
146
Seoncdary addisons/adrenal insufficiency bloods
Low cortisol Low acth normal aldosterone normal renin hyponatremia hyperkalemia hypoglycemia
147
Glucocorticoid replacement
Hydrocortisone
148
Aldosterone replacement
Fludrocortisone
149
Addisonnian crisis
``` reduced consciousness HYPOtension HYPOglycemia HYPOnatramia HYPERkalemia ```
150
DKA bloods
Hyperglycemia (>11) Ketosis (>3) Acidosis (<7.3)
151
DKA mgmt
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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