Tutorials & Teaching on the Wards Flashcards
Give some ddx for acute cough in young children
Bronchiolitis (RSV) – high temperature makes this less likely
Other viral infection e.g. influenza
LRTI or pneumonia – lobar or bronchial pneumonia
Croup
Whooping cough
Laryngomalacia
Foreign body inhalation
Reflux
Heart failure
Repeated intubation in children may increase risk of what?
subglottic stenosis
Premature babies may have repeated bouts of ‘croup’ that is actually subglottic stenosis
What is the difference between polyphonic and monophonic wheeze?
Polyphonic wheeze is more melodic – suggests smaller airway involved e.g. bronchiolitis
Monophonic wheeze is less melodic - occurs in larger airways – tracheomalacia, laryngomalacia
Prolonged focal seizure should make you consider what?
Encephalitis
Babies who are sleepy with reduced feeding =
sepsis until proven otherwise
What percentage of their body weight can children safely lose within the first few days of life?
up to 10%
should regain birth weight by 10 days old
What can cause asymmetry in the way a young baby moves their arms?
more commonly = Erb’s palsy, clavicular fracture
less commonly = cerebral palsy
What is the main thing you are looking for when assessing a child’s red reflex?
congenital cataracts
also congenital glaucoma and retinoblastoma
When can you not assess a child’s fontanelle?
when they are crying - it will be bulging / tense
How does a typical strawberry naevus present?
not present at birth, appears afterwards and may grow over time, usually resolves spontaneosly by 18 months, fades from the inside out
What should you consider in a child with multiple strawberry naevi who presents with noisy breathing?
consider that they may have internal haemangiomas - if there are lots on the outside there may be some on the inside!
could cause airway obstruction if they grow large enough
How would you give a concise handover for a baby to a senior paediatrician?
x week old, born at x weeks/ term, with a history of…/ previously completely well, presents with ….
currently being investigated for/ treated with ….
good / poor response to tx …
main concern is…
How could you investigate a baby with a fever of unknown origin?
repeat temperature
look in ears for any obvious signs of ear infection
examine all over their body for any obvious rashes
listen to their chest
palpate abdomen
FBC, CRP
blood culture
capillary blood gas (lactate)
urine dipstick, MC&S
lumbar puncture
CXR
Can you rely on peripheral capillary refill in babies?
no - it may be prolonged despite them being healthy
use either their forehead or sternum
What is the issue with capillary blood gas taken from a babies heel?
squeezing the heel can cause the sample to haemolyse and affect the results
Top tips for taking a capillary blood gas from a baby?
get someone to distract the child and hold their leg still
use a small amount of lubricant so that the blood forms droplets which are easier to catch on the tube
How can you investigate for viral infections in young children?
nasopharyngeal aspirates - small amount of sterile saline pushed up the nose and then suctioned out
What are the main complications of hypothermia in neonates?
lethargy, poor feeding, reduced release of surfactant from Type 2 pneumocytes which can lead to respiratory distress
Where should you measure a child’s head circumference?
from their eyebrows to their occipital protuberance
HC and AC helps you to determine if a child is symmetrically or asymmetrically small
What can you give to preterm babies to reduce apnea?
caffeine!
When should murmurs in neonates be investigated?
when they persist after 24 hours
consider ECG and echo
What is the main risk of missed cleft palates?
can lead to aspiration
Give one tool that can be used on the ward to quickly assess a jaundiced child
TCB - transcutaneous bilirubin level monitor
What do you need to assess in a NIPE?
Go from head to toe:
Weight and length
Head circumference
Use an ophthalmoscope to look in the eyes
Assess for cleft palate / lip
Heart - auscultate for murmurs
Hips - assess for DDH
Testes - check if descended
Check for patency of anus and hypospadias (boys)
Femoral pulses
Check hands and feet for number of digits
Check over skin for birthmarks and bruises
Reflexes- e.g. Moro’s reflex, palmar grasp
What can you use to decide if transfusion is required in a child with low Hb?
Can look at reticulocyte count to decide if transfusion is needed – if there are enough reticulocytes (>75) you know the bone marrow is working so the Hb may go up on its own
Generally, PO2 is low when a VBG is performed. What may have happened if the PO2 on VBG is high?
child may be on oxygen
At what age do febrile convulsions classically occur?
from 6 months - 6 years
If you don’t know whether meningitis is viral or bacterial =
give aciclovir for viral cover!!!
What should you ask about in the history if suspecting neonatal herpes / herpetic meningitis ?
Is there parental hx of herpes or cold sores?
Differentials for seizures in a young baby?
epilepsy, West syndrome, febrile convulsions, meningitis, encephalitis, sepsis, IVH
Why may CO2 be high on a blood gas post seizure?
because benzos given in seizures are sedative and may cause a mild respiratory depression
What is the quickest way to get imaging of the brain in a neonate?
USS of the fontanelle - quicker than CT head
What may be the cause of a baby becoming cyanotic when breastfeeding but breathing normally otherwise?
Choanal atresia: a congenital disorder in which the nasal choanae, (paired openings that connect the nasal cavity with the nasopharynx), are occluded
palpable purpura =
a vasculitis
What must the clinical picture include to be considered anaphylaxis?
ABC compromise
What is the most common cause of urticaria in kids?
viruses
Potential risk of SABA in children?
can cause tachycardia and hypokalaemia
Asthma can be diagnosed in children aged 5 and up. What are these symptoms called in infants?
multi-trigger wheeze
What is purple tubing used for?
enteral feeds
How can you work out the required length on an NG tube?
NEX measurement - nose ear xiphisternum
How can you tell if an NG tube is in the right place without an X-ray?
if it is in trachea they will cough / cry
can aspirate to determine if in stomach - gastric pH is from 1-5 (may be altered by recent alkaline foods)
you should aspirate before every feed and NEVER feed if pH > 5
