Teaching Flashcards
Difference between acrocyanosis and true cyanosis?
Acrocyanosis is vasospasm of peripheral BV mainly hand and feet effected whereas true cyanosis everywhere will be effected
If a baby is breathing rapidly what investigations need to be performed?
IEM - blood gas, urine sample, urinalysis, BM
Sepsis - blood culture, FBP, septic screen
Lumbar puncture
CXR
CRP
BM
Any hepatomegaly
2 investigations for coarctation of the aorta?
ABPI, femoral pulses
Why are retinas checked before babies are discharged?
Retinal blastomas
Differentials for early tailing on growth chart?
Heart disease, metabolic or neglect, 6 months tailing suggests coeliac
Chronic heart disease presentation in older children?
Growth tailing, breathless on exertion, murmur, femoral pulses off, respiratory infections, cyanosis, hypertension
How does aortic stenosis usually present?
Chest pain
What is a stills murmur?
blood resonating through papillary muscles
What is a venous hum?
Blood resonating from head and neck vessels
When measuring height of a child what plane should the head be in?
Frankfurt plane
If a child has hypothyroidism what are they started on?
Thyroxine
What does GH stimulate release from the liver and what does this do?
IGF-1 which stimulates fat, bone and metabolic effects on the whole body
Symptoms of Turner Syndrome?
Increase nuchal fold, coarctation of aorta, horseshoe kidney, recurrent ear infections, ovaries havent grown, dont make oestrogen
Conditions that can cause a child to grow too fast?
Hyperthyroidism, Kleinefelter Syndrome, Fragile X Syndrome, Marfans
Management of Kleinefelter Syndrome?
Testosterone and maintenance treatment
How will babies who have congenital adrenal hypoplasia appear at birth?
Ambiguous genetalia, lack of aldosterone and cortisol shunts pathway causing increased testosterone
Condition associated to obesity in early childhood?
Prader-Willi Syndrome
How do you calculate fluid bolus for a child? with dka?
kg x 20mls (x10mls for dka)
What 2 situations do you not use 20mls/kg in fluid bolus?
DKA or trauma
How do you work out fluid deficit in a child?
% dehydrated (0/5/8) x weight in kg x 10 (-bolus)
Maintenance fluid in a child, first 10kg, second 10kg, anything over 20kg?
First 10kg = 4ml/kg/hr
second 10kg = 2ml/kg/hr
over 20kg = 1ml/kg/hr
When would you fluid restrict rather than give full maintenance fluid?
Hyponatraemia in cases of sepsis, meningitis, bronchiolitis, renal problems, CNS, vomiting
What is an ideal starting fluid for children?
0.9% saline, 5%dextrose
Define neonate
birth to 28 days
Preterm is classified as what?
Before 37 weeks
Extremely preterm is classified as what?
before 28 weeks
Low birth weight classified as below?
2.5kg
Very low birth weight classified as below?
1.5kg
Extremely low birth weight classified as below?
1kg
Gut issue suffered in premature babies?
Nectrotizing fasciitis
Brain issue that can be suffered in premature babies?
Intra-ventricular haemorrhage
What questions should you ask the parents of a sick child?
UO, wet nappies, bowel motions (pain/blood), behaviour, lethargy, playing
Observations needed on a sick child?
Distended neck veins, SOB, wheeze, accesory muscles, colour/cyanosed, agitated, rash, limp, dehydrated
Charts used to monitor children wellbeing?
PEWS
Initial airway symptoms of foreign body occlusion?
Vomiting, coughing, distress, stridor
What would you look for in C section of child ABCD approach?
HR, murmur, BP, pulses, liver edge, previous cardiac scars
Most common reason for seizure in child?
Febrile seizure
Disability section of ABCD approach in child?
behaviour lethargy posture pupils seizures
If there is found to be decorticate (flexor) posturing in a child what is most likely effected?
Cervical spinal tract or cerebral hemisphere
If there is found to be decerebrate (extensor) posturing in a child what is most likely effected?
Midbrain or pons
E section of ABCDE?
exposure - rash, bruising, infections, mouth for scarlet fever and slapped cheek, sepsis, abuse
What happens in necrotising fasciitis?
gut lining breaks down, distended and red, hyperosmolar feeds, drain bowel perforations
What drugs link to gastroschisis?
cocaine, tobacco
What happens in exomphalos? assocaited with?
First trimester bowel moves into the umbilical cord
Diabetes, turners
What are babies with diaphragmatic hernias prone to?
How do they present?
Pulmonary hypertension, primary shunting
Initially good sats, then ductus arteriosus opens again, shunting, deoxygenated blood around body
Jejunal atresia associated to what?
Usually pathophysiology of it?
Trisomy 21
Decreased blood supply, ischaemia, no bacteria so scars
Volvulus neonatarum symptoms?
Copious vomiting of green bile
3 main causes of lower GI obstruction in newborns?
CF
Meconium ileus
Hirschsprung disease
VACTERL stands for? week what of development?
vertebral anorectal cardiac tracheo-oesophageal esophageal atresia renal limb abnormalities Occur at week 11 of development
Complication that babies usually face due to spina bifida?
Constant bladder stimulation - renal damage
Need intermittent catheterisation
Take folate
what 2 hormones cause penis formation?
Testosterone and DHT
Why is hypospadias becoming more common?
Pesticides/insecticides/hormones in meat, antihistamines
What can form between back fo tongue and where thyroid descends?
thyroglossal cyst
If epidermoid cyst occurs between brows then what needs to be done?
Intracranial scanning as could be mass or within sinuses
Balanitis xerotic obliterans?
Lichen sclerosis in children, premalignant, need circumcised
How can you easily test between inguinal hernia and hydrocoele? Difference?
Light cant be shone through hernia, hernia more risk and complications needing treatment, hydrocele go away by itself
What age is a referral made for undescended testes?
3 months
Blue berry muffin sign?
Baby destroying neuroblastoma malignant tumour and depositing in t cells within the skin
If there is air in the gut with a baby presenting with oesophageal atresia what must be present?
Tracheooesophageal fistula linked to the lower oesophageal pouch
Double bubble sign on xray is indicative of what?
Duodenal atresia
Pneumatosis intestinalis? sign in what condition?
air trapped in bowel wall, sign of necrotising fasciitis
Most common cause of mortality in a baby who suffered congenital diaphragmatic hernia?
hypoplasia of the lungs
What congenital abnormality is usually present in babies suffering meconium ileus?
CF
Symptoms of intussusception?
vomiting, PR bleeding, pain
How does hypertrophic pyloric stenosis present?
non-bilious vomit, pain, 6 weeks old
Rigler’s sign?
when air is present on the insane and outside of the bowel wall, abnormal
Causes of acute abdomen?
Testicular torsion, NSAP, acute appendicitis, malrotation of the intestines, UTI, pneumonia, DKA
Presentation of infant with acute appendicitis?
Unwell for few days, diarrhoea, septic, dehydrated
3 early complications of appendicectomy?
Abscess, ileus, wound infection
Findings for NSAP?
causes?
central pain, no radiation, disappears in 24-36 hours
Viral
Colonic spasm
Intermittent intussusception
Constipation symptoms?
CAuses?
runny stools, multiple stools, difficult to pass, palpable left colon
Diet, lack of fluids, lack of exercise, toilet training bad
2 investigation for UTI?
dipstick them MSU for O&S
What is Dietl’s Crisis?
Flank pain, vomit, severe collapse
Pelvic outlet obstructed by renal vessel crossing
When does midgut return to abdominal cavity from umbilical cord?
What can occur as this happens?
FIndings?
10 weeks gestation
Intestinal malrotation, volvulus of SI, ischaemia
Bilious vomiting, gasless abdomen, guarding, tenderness, pain
How does pneumonia present in a child?
abdominal pain, RR, recent infection
Need xray
3 dangers in abdominal pain?
bilious vomiting, dka, hyponatraemia
