The Sick Child Flashcards
What are the most common acute presentations in children?
URTI (e.g. croup, bronchiolitis) Gastroenteritis Febrile seizures/epilepsy Pneumonia Asthma
Describe the key differences between bronchiolitis, croup (acute laryngotracheobronchitis) and epiglottitis.
Bronchiolitis (RSV) - gradual onset, rales, wheeze, low grade fever - supportive treatment
Croup (parainfluenza virus) - gradual onset (often at night), barking cough - dexamethasone
Epiglottitis (H influenzae B) - stridor, drooling, high fever, tripod position - abx and steroids
Describe the emergency management algorithm of an unresponsive, unconscious child.
DRS ABCDE
- danger, response, shout for help
- airway: place in ‘neutral position’ for babies, or ‘sniffing the morning air’ for infants/children
- assess breathing; give 5 rescue breaths
- assess circulation (carotid, brachial, radial pulse for 10 seconds only)
- 15 compressions (2 fingers for baby, heel of hand for infant/child)
- then 5 breaths : 15 compressions
Describe the emergency management algorithm of a choking child.
Assess severity (is there a cough? is it effective?)
- effective cough: encourage, assess for signs of deterioration
- ineffective cough, conscious: 5 back slaps, 5 thrusts (chest for <1yr, abdominal for >1yr)
- ineffective cough, unconscious: 5 rescue breaths, then commence CPR
What is the diagnosis?
projectile vomiting, milky vomitus, abdominal distension, abdominal pain, around 1 month old
Pyloric stenosis
What should be suspected in a baby that vomits bile? Describe the investigation of choice and management.
GI malrotation. Prompts upper GI contrast with follow through. Surgery is required to prevent volvulus.
What is the diagnosis?
child 1month-2years, draws legs up, grasps abdomen, sausage shaped mass in abdomen
What is the management?
Intussusception
blowing air through the rectum dislodges the mass in 85% of cases. otherwise, surgery is needed
What are the two key signs of testicular torsion / epidydimal orchitis?
A focal bruising spot on the testes, red scrotum
What is the term for inability to retract the foreskin? What are the three main conditions related to this and what is the management for each?
Phimosis
- physiological phimosis - steroids
- pathological phimosis (white, scarring) - circumcision
- paraphimosis - foreskin is stuck - surgery to prevent ischaemia
What are the three main diagnoses for swollen testes in children?
- hydrocele (nontender, transilluminates)
- idiopathic scrotal oedema (analgesia +/- antihistamines)
- hernia
What is hypospadias?
Disstructure of the penis; urethra is present on underside. Surgery required to straighten the penis and move the urethra.
In global health, which pathogen is responsible for pneumonia in children with HIV?
Pneumocystis jiroveci (PCP)
In global health, describe the main causes, preventative measures, and treatment of diarrhoea.
- causes: E. coli, rotavirus
- prevention: clean drinking water, hygiene, breastfeeding, vaccination
- treatment: oral rehydration solution (ORS), a mixture of clean water, salt, and sugar + zinc supplementation (reduces stool volume and duration)
In global health, what are the WHO 6 actions to minimize preventable child deaths?
- breastfeeding
- skilled attendants at/after birth
- nutrition
- family knowledge of child health danger signs
- water, sanitisation, and hygiene
- immunization
In global health, which measurements are used for assessment of malnutrition?
- midarm circumference (<115mm)
- weight for height (
What are marasmus and kwashiorkor?
- marasmus is complete lack of nutrients
- kwashiorkor is lack of protein intake, with adequate carbohydrate intake
Describe the immediate management of malnutrition.
2 phases - stabilization -> rehabilitation
give 2hrly feed, or 10% glucose/sucrose. do not give IV, and do not give standard ORS (high sodium, low potassium). instead, give ReSoMal
What are the major causes of neonatal jaundice?
- breastmilk jaundice
- Gilbert’s syndrome
- biliary atresia
- choledochal cyst
- ‘normal’ (viral, hypothyroid, genetic)
What are the major causes of neonatal/infantile vomiting?
Bilious:
- haemodynamic instability (peritonism, complete obstruction)
- malrotation/volvulus (follow through upper GI contrast)
Non-bilious:
- pyloric stenosis
- GORD, CMPA
Name the main live attenuated vaccines.
Measles, mumps, rubella, varicella, yellow fever, rotavirus, influenza, oral polio, BCG (TB).
Name the inactivated suspension vaccines.
Pertussis, typhoid
Name the toxoid subunit vaccines.
Diphtheria, tetanus, (pertussis)
Name the polysaccharide subunit vaccines.
Pneumococcal, typhus
Name the conjugate vaccines.
HiB, MenC
