Random Flashcards by Ellen Thomas

Antenatal risk factors for infection of neonate?

PROM
Preterm birth
GBS current or past colonisation
Intra-partum fever over 38

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How much and what would you give as a fluid bolus to a shocked child?

20ml/kg of 0.9% NaCl

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Gram +ve, cocci in chains?

Group B strep

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Long term complications of bacterial meningitis?

Amputation due to necrosis of peripheries
Hearing and visual loss
Learning difficulties, behavioural
Epilepsy
Co-ordination and movement disorders

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Causes of respiratory alkalosis? What would blood results show?

Hyperventilation (due to anxiety or by excessive mechanical ventilation)

High pH, normal O2, low CO2, normal HCO3 and base excess

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What is staphylococcal scalded skin syndrome?

Red blistered skin resembling a burn/scald which is caused by S. aureus.

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What’s the pathophysiology of SSSS?

Certain strains of S. aureus cause skin damage by releasing toxins.

The toxins break the epidermal adhesion molecule (desmoglein 1) which means skin cells can’t stick together. Skin breaks up.

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Who gets SSSS?

Children under 5

Especially neonates

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Clinical features of SSSS?

Generalised erythema
Skin tenderness
Prodromal sore throat, conjunctivitis

Tender, large blisters in flexures
These rupture easily to reveal base which gives rise to scalded appearance.

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Differential diagnosis for SSSS?

Toxic epidermal necrolysis (drug reaction)

Bullous impetigo (blisters without generalised erythema)

Toxic shock syndrome

Scarlet fever

Pemphigus (autoimmune blistering of skin)

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Investigations of SSSS?

Swabs (identify bug and sensitivities)

Biopsy

Nasal swabs of relatives, carers etc

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Management of SSSS?

Supportive fluids, electrolytes

Emollient to alleviate tenderness and pruritus

Topical fusidic acid
PO or IV flucloxacillin

Analgesia (Paracetamol, opioid)

Physio to keep them moving despite pain

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Complications of SSSS?

Dehydration
Cellulitis
Sepsis
Pneumonia

Need for ITU, special treatment in Burns Unit

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A child has a seizure, what do you need to know from history?

Temperature? Signs of meningitis (rash, meningism)

Recent head trauma

Metabolic disorders (T1DM)

Change in personality, headaches, vomiting (in morning)

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List some conditions which you’d find neurological signs?

Meningitis (Kernig’s)

Cerebral palsy (Hypertonia, hyperreflexia)

Muscular dystrophy

Chromosomal (Down’s)

SOL: papilloedema

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Advice to give parents for if their child has another seizure?

Keep child safe (move away sharp objects, anything they could hurt themselves on)

Reassure child

Call 999 if seizure lasts more than 5 mins, there are multiple seizures which she doesn’t recover from between

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A neonate with jaundice. What do you want to know from parents?

Onset (within or without 24 hrs)

Parents: any genetic conditions in family (G6PD, spherocytosis)

Rh and ABO group of mother and baby

Breast milk fed?

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What is the likely cause of jaundice lasting more than 2 weeks in a well child?

How long could this jaundice last?

Breast milk jaundice

4 months

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When is jaundice an issue with newborns?

If onset before 24 hrs or over 2 weeks

Group B strep
What does it look like?
What’s its actual name?

Gram +ve
Cocci
Chains

Strep. agalactiae

Are Neisseria men and gon gram +ve or negative?

Negative

What systems would you monitor after giving gentamicin?

Hearing

Renal

Initial investigations for a possible NAI?

Full body examination
Bloods: clotting, FBC
Papilloedema: to look for possible cerebral oedema

You’ve just intubated and ventilated a patient. What should you do?

CXR to ensure correct positioning

Resp alkalosis in a ventilated child. Why?

Ventilation rate too high

Tests for TB?

CXR Interferon gamma release assay Mantoux test

Eye signs in seizures?

Repetitive blinking Staring Eyes rolling up Dilated pupils

Causes of haematuria (to do with basement membrane nephritis).

Good pastures Post-strep glomerulonephritis IgA nephropathy

Nephrotic vs nephritic?

Nephrotic: podocytes, protein Nephritic: basement membrane, haematuria

Causes of nephrotic syndrome?

Membranous nephropathy FSGS Minimal change disease

Causes of microcytic and macrocytic anaemia?

Micro: iron deficiency, thalassaemia, sickle cell Macro: folate, B12 deficiency, alcohol excess

What are some haemolytic anaemias?

Spherocytosis G6PD Thalassaemia Sickle cell

What are some tests to investigate anaemia?

Serum iron Serum ferritin Hb electrophoresis Total iron binding capacity

Management of ADHD?

Methylphenidate (Ritalin) Atomoxetine Dexamfetamine

Chronic ear and chest infections, dextrocardia. Cause?

Primary ciliary dyskinesis Cilia fail to beat properly, infections and mucus build up

Cardiac defect associated with Turner's syndrome? What are the symptoms?

Coarctation of aorta Often weak femoral pulses, upper limb pulses are fine because coarctation is after sub-clavian has branched off

A child presents in acute renal failure after having bloody diarrhoea for a few days?

Haemolytic uraemic syndrome | E. coli 0157

Investigation of intussusception?

USS first line | AXR

Complications of intussusception?

Paralytic ileus | repeat (30%)

Guthrie's test marker for CF?

Immuno-reactive tripsinogen

Genetic mutation in CF?

CFTR gene on chromosome 7 at position delta f 508

Treatment of pancreatic insufficiency in CF?

Vit AKED Pancreatin Insulin

Causes of repeat intussusception?

Polyp Meckel's diverticulum Anatomical abnormality

What's a rule that can be used to estimate burns extent?

Wallace's rule of 9s Head + neck = 9% Arm = 9% Anterior leg = 9%, posterior leg = 9% Anterior chest = 9%, posterior chest = 9% Anterior abdomen = 9%, posterior abdomen = 9% Palm size is roughly equal to 1%

What is the formula used to calculate fluid requirement in burns patient?

Parkland formula | Amount of fluid (ml) = area of burn (%) x weight x 4

Different degrees of burns? What do they look/feel like?

1st - superficial: epidermis, red, painful 2nd - partial thickness: - superficial dermal, pale pink, blisters - deep dermal, white, reduced sensation 3rd - full thickness: white, brown, black, no pain

Management of burns?

First aid: cool water, clingfilm ``` ABCDE Fluids, analgesia Correct electrolytes Prevent infection Escharotomies: division of encasing band of burn tissue allows better ventilation ```