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Birth and Early Years > The Sick Child > Flashcards

The Sick Child Flashcards

1
Q

What are the questions to ask about a seizure in a witness history?

A
  • What were they doing when the fit started?
  • How did the fit start? How long did it last?
  • Was there LOC?
  • Bladder / bowels opened?
  • What were the movements like, and in which parts of the body?
  • Was there eye rolling?
  • Was there tongue biting?
  • What was the tone?
  • What was the colour?
  • How did it stop (self resolving?)
  • Were they sleepy afterwards (how long was the post-ictal phase?)
  • Was there headache afterwards?
  • Was there any injury sustained?
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2
Q

What should be asked in the history about pre-fit activity?

A
  • Was there a fever?
  • Has the child been unwell recently?
  • Did the child complain of anything prior to the fit?
  • Were they exercising? (Cardiac syncope may come suddenly at rest, or during exercise)
  • PMHx
  • Birth Hx
  • Has the child been developing normally?
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3
Q

Describe the examination of a child who has presented having had a fit.

A
  • The fit
    • ​Generalised?
    • Eyes rolled?
    • Jaw clenched?
    • Cyanosed?
    • Absence seizure?
    • Focal seizure?
  • After the fit
    • ​Children can be drowsy and confused (post-ictal)
    • ABCDEFG
  • Full neurological examination when possible
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4
Q

Describe febrile convulsions.

A
  • Affect 3% of children; genetic predisposition.
  • Occur between 6 months and 6 years of age.
  • Usually brief, generalised tonic-clonic seizures occuring with a rapid rise in fever.
  • Advise family about management of seizures.
  • If simple - does not affect intellectual performance or risk of developing epilepsy.
  • If complex, 4-12% risk of subsequent epilepsy.
  • DO NOT ASSUME ‘febrile convulsion’. Remember that CNS infections (meningitis and encephalitis) also cause fever and fits. Check for signs of meningism / bulging fontanelle. Check for personality or behaviour change.
  • Even in this case of a febrile convulsion, remember to make sure that you find the cause of the dever and assess the child for serious bacterial infection. This includes a thorough examination and urine check at the least. Blood tests may be required.
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5
Q

Describe the diagnosis and classification of childhood epilepsy.

A
  • The diagnosis is based on 2 or more unprovoked seizures.
  • Childhood epilepsies are classified according to syndromes - a constellation of signs, symptoms and investigations that define a distinct recognisable clinical disorder.
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6
Q

Describe the temporal classification of headaches.

A
  • If a patient presents with an acute headache (first time presentation) you have to assess whether or not this is secondary to something.
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7
Q

What are the signs and symptoms associated with CNS tumours in children?

A
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8
Q

Describe the primary assessment and management of a child in a coma.

A
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9
Q

Describe the secondary assessment and emergency treatment of a child in a coma.

A
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10
Q

Describe the Glasgow Coma Scale

A
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11
Q

After immediate ABCDE, describe the management of a child in a coma.

A
  • Head positioned midline and tilted up 20° - 30°.
  • Fluid restriction with isotonic fluids.
  • Intubation and ventilation if GCS <9.
  • If intubated, maintain nornocapnia (partial pressure of CO2 in arterial blood 4.5-5.3kPa).
  • Osmotic diuretics (e.g. Mannitol) to reduce raised ICP.
  • Maintain high normal blood pressure in order to maintain cerebral perfusion pressure.
  • Maintain normothermia.
  • Hypotension or hypoxaemia must be avoided during treatment.
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12
Q

What are the clinical features to assess in a child with stridor?

A
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13
Q

What are the differential diagnoses for stridor?

A
  • Croup
  • Epiglottitis
  • Bacterial tracheitis
  • Inhaled foreign body
  • Chronic stridor
  • Other rare causes
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14
Q

Describe the basic management of acute upper airway obstruction.

A
  • Reduce anxiety by being calm, confident and well-organised.
  • Observe carefully for signs of hypoxia or deterioration - agitation, fatigue, drowiness or cyanosis. Provide oxygen is required and tolerated.
  • DO NOT examine the throat with a spatula! It may precipitate upper airway obstruction.
  • Oral, nebulised or IV steroids are beneficial in croup and have similar speed of onset (90-120 minutes).
  • If severe, administer nebulised adrenaline and contact an anaesthetist.
  • If respiratory failure develops from increasing airway obstruction, exhaustion or secretions block the airway, urgent tracheal intubation is required.
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15
Q

Describe bronchiolitis.

A
  • Most common serious respiratory infection of infancy.
    • 90% aged 1-9 months.
  • RSV is the pathogen in 80% of cases. Other causative agents are parainfluenza virus, rhinovirus, adenovirus, influenza virus and human metapneumovirus.
  • Infants born prematurely who develop bronchopulmonary dysplasia or with other underlying lung disease, such as cystic fibrosis, or have congenital heart disease are most at risk from severe bronchiolitis.
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16
Q

Which cases of bronchiolitis do you need to admit to hospital?

A
  • Apnoea (observed or reported)
    • Not breathing for >20 seconds
  • Persistent oxygen saturation of <92% when breathing air.
  • Inadequate oral fluid intake (50–75% of usual volume).
  • Severe respiratory distress – grunting, marked chest recession, or a respiratory rate over 70 breaths/minute.
  • Hospital admission is supportive.
    • ​Humidified oxygen
    • Infant monitored for apnoea
    • Fluids may need to be given IV or via NG tube.
    • Assisted ventilation in the form of CPAP (continuous positive airway pressure) or else mechanical ventilation is required in a small percentage of infants admitted to hospital.
17
Q

Describe asthma diagnosis in children.

A
  • Symptoms worse at night and early in the morning.
  • Symptoms that have non-viral triggers.
  • Interval symptoms (i.e. between acute exacerbations).
  • Personal or family Hx of atopic disease.
  • Positive response to asthma therapy.
  • Asthma is usually diagnosed from hx and examination alone.
18
Q

Describe the presentation of a child with pneumonia.

A
  • Fever, cough and rapid breathing are the most common presenting symptoms.
  • Examination reveals increased respiratory rate, nasal flaring and chest indrawing.
  • Dullness on percussion.
  • End-inspiratory coarse crackles over the affected area but the classic signs of consolidation with decreased breath sounds and bronchial breathing over the affected area are often absent in young children.
  • Oxygen saturation may be decreased.
19
Q

What are the causative pathogens of pneumonia in the neonate?

A
  • Organisms from the mother’s genital tract, particularly group B streptococcus, but also Gram-negative enterococci.
20
Q

What are the causative pathogens of pneumonia in infants and young children?

A
  • Respiratory viruses, particularly RSV, are most common, but bacterial infections include Streptococcus
    pneumoniae or Haemophilus influenzae.
21
Q

What are the causative pathogens of pneumonia in children >5?

A
  • Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia pneumoniae are the main causes.
  • At all ages Mycobacterium tuberculosis should be considered.
22
Q

What are the causes of vomiting in infants?

A
23
Q

What are the causes of vomiting in preschool children?

A
24
Q

What are the causes of vomiting in school age children and adolescents?

A
25
Q

What are the red flag clinical features in the vomiting child?

A
26
Q

What are the differentials for acute abdominal pain in:

  • Infants <1 year
  • Toddler and pre-school children aged 1-5
  • School children 5-12 years
  • Adolescents >12 years
A
27
Q

What is the most frequent cause in the developed world of diarrhoeal illness in children?

A

Rotavirus infection

28
Q

What are the other, less common causes of diarrhoeal illness in children?

A
  • Bacterial causes are less common in the developed world.
  • Campylobacter jejuni infection (suggested by the presence of blood in the stools. Often associated with severe abdominal pain.
29
Q

What clinical features are present in a severely dehydrated child?

A
30
Q

Describe the examination findings of a child who is clinically dehydrated vs. a child who is not clinically dehydrated vs. a child who is in shock.

A
31
Q

Describe the fluid management of a child with gastroenteritis but who is not clinically dehydrated (prevention).

A
  • Continue breastfeeding and other milk feeds.
  • Encourage fluid intake to compensate for increased GI losses.
  • Dicourage fruit juices and carbonated drinks.
  • Oral rehydration solution as supplemental fluid if at increased risk of dehydration.
32
Q

Describe the fluid management of a child with gastroenteritis who is clinically dehydrated.

A
  • Give fluid deficit replacement (50mL/kg) over 4 hours as well as maintenance fluid requirement.
  • Give ORS often and in small amounts.
  • Continue breastfeeding.
  • Consider supplementing ORS with usual fluids if inadequate intake of ORS.
  • If inadequate fluid intake or persistent vomiting, consider giving ORS via NG tube.
33
Q

Describe the fluid management of a child with gastroenteritis who is in shock.

A
  • IV therapy - give a bolus of 0.9% NaCl solution. Repeat if necessary.
  • If remains shocked, consider consulting paediatric intensive care specialist.
34
Q

What are the red flag signs and symptoms in a child with constipation?

A

Birth and Early Years (31 decks)

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