Revisions deck (VERY HELPFUL) Flashcards
sources of fever
otitis media
viral illness:
- viral exanthum e.g. measles
- sesonala influenza
- covid-19
uti
meningitis
pneumonoa
cellulitis
sepsis
how to screen if a chuld is unwell
A to E
- RR is the most important first sign to look for
PEWS
nursing/parent concern
RR
resp distress
oxygen
heart rate
level of cosncpusness
not temp or BP
point of care tests - remember
capillary blood gas
blood glucose
urine dipstix
nasopharngeal aspirate e.g. flu, cobid rsb
complifcations of otitits media
hearing loss
balance problem
perforation
mastoiditis
venous sinus thrombosis
maculopapular rashes
roseola infantum
slapped cheek
measles (cough, coryza, conjunctivitis)
scarlet fever
vesicular rahses
chicken pox - herpes varicella zoster
hand foot and mouth disease
herpes simplex virus- herpes 1
erythema multiform- herpes 1
petechial (<2mm)/ pupuric (>2mm) rash
Non blanching
- meningococcal
- Henoch-Schönlein purpura (HSP) - lower limbs due to gaviravity
management of possible sepsis
management of possible sepsis
kawasaki
- One of the most common vasculitides in children; also occurs in adults.
- Acute self-limiting an acute self-limiting inflammatory disorder affecting predominantly medium sized arteries, particularly coronary arteries causing aneurysms in 15-25% if untreated.
- Commonest causes of acquired heart disease in children in developed countries.
Presentation
CRASH AND BURN
Management: (no laboratory investigation included in diagnostic criteria):
Systemic inflammation with mild anaemia, leucocytosis with left shirt and thrombocytosis (end of week 2).
Raised ferritin (acute phase reactant). Needs ECG, CXR and cardiac ECHO.
Treatment: IV Ig; Aspirin - high dose in acute phase followed by low dose maintenance.
viral vs bacterial meningitits
viral:
- entervorus
- herpes virus
bacterial
- younger: Neisseria meningiditis (meningococcal), E.coli, Group B strep
- adults: Haemophilus influnzae and streptococcus pneumoniae
neisseria meningiditis
cough type. andspecific causes summary
examples of increased work of breathing
Nasal flaring
Expiratory grunting – increase PEEP
Use of accessory muscles - sternomastoids
Retractions – suprasternal, SC and IC
features of
bacterial
- high fever
- pain- pleurisy
- no whezze
viral
- coryzal
- young
- wheeze
features of
bacterial
- high fever
- pain- pleurisy
- no whezze
viral
- coryzal
- young
- wheeze
summary of LRTI management
UTI urine dipstix and MCS findings
management of UTI
indication for urianry tract Ultrasound
Under 6 months with first-time UTI that responds to treatment – US within 6 weeks.
6 months to 3 years:
- Atypical UTI- organism
- Seriously ill.
- Septicaemia.
- Failure to respond to suitable antibiotics within 48 hours.
- Infection with non-E.coli organisms.
- Poor urine flow.
- Abdominal mass.
- Raised creatinine.
Recurrent UTIs
- 3 or more UTIs with lower UTI.
- 2 or more UTIs with acute upper UTI (acute pyelonephritis).
- 1 episode of acute upper UTI and 1 episode of acute lower UTI.
Kocher Criteria for Septic Arthritis
transient synovitis vs septic arthritis
differential diagnosis of an autrauamtic limp
antibiotic prescribing
antibiotic prescribing
typical clinical features of croup
hoarseness
barking cough
stridor
infectious differential for croup
Acute epiglottitis
Bacterial tracheitis
Severe LN swelling
Tonsillar abscess
Retropharyngeal abscess
non infectious differential for croup
Acute laryngeal oedema (allergy)
Inhaled foreign body
Inhalation of smoke or hot fumes
Trauma to throat
Hypocalcaemia
Psychological (VCD)
investigations for bronchiolitis
- Naso-pharyngeal aspirate PCR.
- Blood gas: assess respiratory status.
- Blood tests: FBC, CRP rarely helpful. U&E to assess hydration.
- CXR: only to exclude complications.
clinical diagnosis!
complications of bronchiolitis
Acute: dehydration, lung collapse, pneumonia, respiratory failure.
Chronic: persistent bacterial bronchiti, bronchiolitis obliterans (adenov)
(Scarring and fibrosis of small airways
manaagment of bronchiolitis
- supportive: oxygen, nutirtion, IV fluids
NO SALBUTAMOL
management of viral induced wheeze
-nebulised salbutamol
differentials for wheeze
examples of chronic asthma treatment drugs
LTRA- suidical ideation
theophylline- awful drug
causes of central cyanosis in neonates
Airway obstruction
- choanal atresia
- larygomalacia
- macroglossia
- micrognathia or rethrognathia (Pierre-Robin syndrome)
Pulmonary
- alveolar capillary dysplasia
- lobar emphysema
- pneumonoa/PE/ pneumo
- perissdtent pulmonary hypertension of newborn
- pulmonary hypoplasia
- resp distress syndrome
- transient tachypnoea of the newborn**
chonal atresia
laryngomalacia
micrognathia (pairee robin sequence)
congential lobar emphysema
congenital diaphragmatic hernia
congneital diaphagmatic hernia
congenital heart disease presentations at birth
heart murmurs
intussusception
red flags for constipation
constipation summary
: <3 complete stools/week.
Large, infrequent stools (Bristol 3/4).
‘Rabbit droppings’ (Bristol 1)
Overflow soiling: very loose/smelly.
unaware passed.
dehyration summary
presentation of dehydration
dehydration risk factors
diarrhoea management
causes of vomiting in infants
Gastro-oesophageal reflux
Feeding problems
Infection:
Gastroenteritis
Upper/lower respiratory tract infection
Whooping cough
Urinary tract infection
Meningitis
Intestinal obstruction
Pyloric stenosis
Atresia – duodenal and other sites
Intussusception
Malrotation/Volvulus
Strangulated inguinal hernia
Hirschprung disease
Inborn error or metabolism
Congenital adrenal hyperplasia
Renal failure
causes of vomiting in older children
Gastroenteritis
Appendicitis
Intestinal obstruction¶
Intussusception/malrotation/volvulus
Adhesions/foreign body (bezoars)
Coeliac disease
Cyclical vomiting syndrome§
Torsion of the testis
Infection: upper/lower UTI/RTI
septicaemia, meningitis
Migraine§
Raised intracranial pressure
Renal failure
Diabetic ketoacidosis §
Inborn errors of metabolism¶
Alcohol/drug ingestion§
Bulimia/anorexia nervosa§
(¶ - pre-school; § school aged/adolescents)
presentation of pyloric stenosis
Vomiting is non-bilious and forceful; may become more forceful over time.
Vomiting immediately after feeds; GOR vomiting not forceful and later after feeds.
Infants have strong appetite; hungry after vomiting.
Peristaltic waves in upper abdomen from left to right immediately before vomiting.
Palpable hypertrophied pylorus (known as ‘olive’) – pathognomonic.
investigation findigns for pyloric stenosis
Blood gas: Metabolic alkalosis
Hypochloraemia Hypokalaemia ± hyponatraemia.
management of pylorisic stenosis
NBM
rehdyration
Ramstedt pyloromyotomy
options for cows milk protein allergy
assessment for child who is short of age
Predicted height:- - (Father’s + Mother’s height/2) + 7cm (boys) or -7cm (girls).
- 9th to 91st centile range: ± 10cm (boys) or 7.5cm (girls).
Screening tests:
* FBC, U&E, LFT.
* Vitamin D
* Coeliac screen
* Thyroid function
* Karyotype (in girls)- Turners
* Bone age – x-ray left wrist and hand
* (Delayed bone maturity: endocrine disorders e.g., growth hormone deficiency
* constitutional delay of growth and puberty)
*
cuases of short stature in children
presentation of down syndrome
presentation of Turner Syndrome
classification of headache
red flags for SoL
differnntials for suspected seizure
Seizures
Pyrexial convulsion
Apyrexial convulsion
Epilepsy
Associated/triggering conditions
Inflammation (meningitis/encephalitis)
Trauma (accidental/non-accidental)
Intoxication/poisoning
Medication/drug withdrawal
Metabolic (hypo-glycaemia, -calcaemia)
Hypoxia/Stroke
Paroxysmal disorders
Breath-holding spells
Reflex anoxic seizures
Syncope
Migraine
Benign paroxysmal vertigo
Reflux (Sandifer Syndrome)
Cardiac arrhythmias
status epilpeticus
Generalised convulsive SE defined as:
‘generalised convulsion lasting ≥30-minutes’ – or –
‘successive convulsions over 30-minutes so frequent that patient does not recover consciousness between them’
investigations for seizures
Bedside glucose monitoring in all children.
FBC, U&E, LFT, CRP, BG, Blood culture.
Anticonvulsant levels (if epilepsy).
Toxicology screen (if appropriate).
Plasma ammonia and lactate, serum amino-acids and urine amino- and organic-acids (seek metabolic disorder).
CT head (if NAI/SOL suspected).
ECG in all with prolonger seizures – rule out prolonged QT-syndrome.
epilepsy syndromes
immune thrombocytopaenic purpura
- no need for treatment
nephrotic syndrome
neonatal jaundice classification
aetiology of neonatal jaundice
phototherapy for jaundice
