Summary Flashcards
differentials for periorbital swelling in a child?
VITAMINCDEF
infection/inflammation/immune-nephrotic syndrome, preseptal and orbital cellulitis, angioedema and anaphylaxis, allergic conjunctivitis
trauma-orbit blowout fracture
metabolic-hypothyroidism e.g. hashimoto’s thyroiditis-most common age in children is adolescence, but can occur at any time
neoplasm
causes of neonatal cyanosis?
cardiac: transposition of great arteries other R to L shunt defects e.g. tetralogy of fallot-few present with severe cyanosis in 1st few days of life. ?large VSD common mixing-AVSD e.g. Downs syndrome resp: resp distress syndrome pneumonia-*group b strep pneumothorax diaphragmatic hernia
main differential for blood in stools in an otherwise well child under 4mnths of age?
cow’s milk protein allergy
biggest RF for transient tachypnoea of the newborn?
C section
major RF for neonatal RDS?
prematurity
major RF for aspiration pneumonia in neonate?
meconium staining*
normal RR for children under 1 year of age?
30-40
normal RR for children aged 1-2 years?
25-35
normal RR for children aged 2-5 years?
25-30
normal RR for children aged 5-12 years?
20-25
red flags to be aware of to alert parents to present again with child with bronchiolitis?
increasing resp distress-nasal flaring, severe chest recession, grunting
apnoea or cyanosis
fluid intake 50-75% of normal, or no wet nappy for 12 hours
exhaustion-waking only on prolonged stimulation, not responding to normal social cues.
children at increased risk of dehydration?
under 1 year, espec. under 6 months
6 or more diarrhoeal stools in last 24hr
3 or more vomiting episodes in last 24hr
low birth weight
have not been offered or not able to take supplementary fluids before presentation
have stopped breastfeeding during the illness
evidence of malnutrition
features suggestive of hypernatraemic dehydration?
jittery movements increased muscle tone hyperreflexia convulsions drowsy/coma
NICE recommendations for stool culture in a child who presents with diarrhoea and vomiting?
if suspect septicaemia or
blood and mucus in stool or
child immunocompromised
consider if child recently been abroad, diarrhoea not improved by 7 days or unsure of diagnosis of gastroenteritis
what diet may be helpful for some children with epilepsy e.g. lennox-gastaut syndrome?
ketogenic diet-high fat, low carb, controlled protein diet.
advantages of breast feeding?
Mother: bonding involution of uterus protection against breast and ovarian cancer cheap, no need to sterilise bottle contraceptive effect (unreliable)
Immunological:
IgA (protects mucosal surfaces), lysozyme (bacteriolytic enzyme) and lactoferrin (ensures rapid absorption of iron so not available to bacteria)
reduced incidence of ear, chest and gastro-intestinal infections
reduced incidence of eczema and asthma
reduced incidence of type 1 DM
Reduced incidence of sudden infant death syndrome
Baby is in control of how much milk it takes
disadvantages of breast feeding?
transmission of drugs
transmission of infection
nutrient deficiency-Vit D with prolonged BF
Vit K deficiency
breast milk jaundice (cause of prolonged jaundice-baby more than 2 wks)
features of NEC (necrotising enterocolitis) on AXR?
- dilated bowel loops, often asymmetrical in distribution
- bowel wall oedema
- pneumatosis intestinalis-intramural gas
- rigler’s sign-air both inside and outside the bowel wall
- pneumoperitoneum-due to bowel perforation
- portal venous gas
- air outlining the falciform ligament (football sign)
how long after birth do most neonatal intraventricular haemorrhages occur?
within 72hrs
treatment is largely supportive
but if hydrocephalus and rising ICP develop, then indication for shunting
options for managing young child with dehydration?
oral rehydration challenge-with dioralyte
if unsuccessful then NGT for fluids
if unsuccessful then IV fluids
how are rehydration fluids calculated in a child?
%dehydration X body weight X 10
antibiotic treatment for patient with NEC?
IV flucloxacillin, gentamicin and metronidazole
guidelines for neonatal resuscitation?
- following birth, dry the baby, maintain temp and start the clock
- assess tone, breathing and HR
- open airway to give 5 inflation breaths if gasping or not breathing
- reassess
- if no increase in HR, ensure inflation breaths are adequate by checking chest expansion, if not moving assume inadequate, recheck head position, consider 2 person airway control
- if chest moving but HR still not detectable or is less than 60, start chest compressions at 3:1
- reassess HR every 30 s
- consider IV access and drugs
