select Flashcards
In constipation after initial disimpaction, how long should stools be kept soft for?
3-6m
croup all children should get what rx
single dose dex po
coryza and mild fever –> dry cough –> breathless, wheeze, crackles.
Decreased feed
Bronchiolitis
Bronchiolitis pathogen?
RSV
Bronchiolitis age
<1y
coryza, fever–> stridor –> barking cough, wheeze and hoarse
Croup
Croup age
6m-2y
Who should be admitted in croup
mod/sev/<6m
Epiglottitis age
1-6y
What do contacts get in epiglottitis
Rifampicin prophylaxis
Cold agglutins indicate what?
Mycoplasma pneumonia
What do cold agglutins cause?
Haemolytic anaemia
4w old with stridor?
Laryngomalacia
Do you treat wheezy baby with or without asthma differently?
no
a wheeze developed <2y is likely to persist into childhood? t/f
false likely to become asymptomatic mid childhood
Assessing probability of asthma in an older child
PEFR measurements 2-4w, take mean variability- if >20% = positive test
Unsure of asthma diagnosis wyd?
Either watchful waiting with review, or monitored initiation of rx (6-8w bronchodilator then diagnose or not)
asthma maintenance steps
- SABA
- very low dose ICS
- +LABA (or LTRA)
- ±LABA, increase ICS to low, add LTRA/LAMA (refer if <5yo)
- Increase ICS to medium or add 4th drug e.g. theophylline and refer
- Daily steroid tabs, maintain medium ICS
Example of ICS in paeds
fluticasone or budesonide
Moderate acute asthma =
PEFR 50%
Acute severe asthma?
sentences
33-50%
HR >140/125 (under/over 5yo)
RR>40/30
Life threatening asthma
SpO2 <92%
PEF <33%
Silent chest, cyanosis etc
Management acute asthma
O2
Salbutamol inh in mild/mod 2-10puffs/10-20m
neb in AS/LT- O2 driven, 2.5-5mg/20-30min
Prednisolone (10mg <2y, 20mg 2-5y, 30-40mg >5y) for 3 days
Ipratropium if refactory 250mcg added to the salbut nebs every 20-30m
Length of whooping cough
6-8w
Erythromycin is only effective at what stage of whooping cough?
Before the whoop is heard (paroxysmal stage) so give early in the catarrhal stage
Normal APGAR at one minute
7-10
If baby isn’t breathing at 1m what is done?
Head to neutral and 5 inflation breaths
what if not breathing after first 5 inflation breaths?
Recheck head position
Consider 2 person airway control or other airway manoeuvres
Repeat inflation breaths
What do you do once breaths are successful but HR<60BPM?
Chest compresssions 3:1 breath
How often do you reassess HR
30s
Main cause gastroenteritis
Rotavirus
Recommended volume of formula feed?
150ml/kg/24hr (given in 6-8 daily feeds)
Rx GORD
Only if FTT/faltering
Check volume of feed
1st line Thickening agents
2nd line gaviscon
3rd PPH/H2 receptor antag
General: upright position, wind
Surgical fundoplication if recurrent aspiration
left subclavicular thrill
continuous ‘machinery’ murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
PDA
ejection systolic murmur, fixed splitting of S2
ASD
harsh pan-systolic murmur at lower left systolic edge which is louder in smaller defects
Parasternal thrill
VSD
Boot shaped heart and oligaemic lung fields on CXR
Tetralogy
Rx PDA
Prostaglandin inhibitors- NSAIDs
when do you give babies prostaglandins?
In transposition of great vessels to keep DA open
Weak femoral pulses, BP higher in arms
Coarcatation of the aorta
Cardiac assoc with Turners
Coractation and bicuspid valves
Hand preference before ___ is worrying
10m
when can they sit?
6m
When do children get stranger anxiety
7m
When do children drink from cup
15m
When is attachment behaviour seen
6-36m
What are insecure avoidant infants like
Suppress emotion
What are securely attached infants like
distressed in absence of caregiver, happy when return
What are insecure ambivalent attachment infants like
distressed on separation, angry on reunion
What are disorganised attached children like
mix of no emotion/distressed and angry
Abnormalities must be present before ___ for a diagnosis of ASD
36m
