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GP > Unwell child > Flashcards

Unwell child Flashcards

1
Q

In what cases would you do a septic screen?

A

A child that is showing signs of sepsis, or one who has signs of an infection

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2
Q

What does a septic screen consist of?

A
  1. Blood tests, blood gas
    (FBC, U+E, lactate, glucose)
  2. Urine sample
  3. LP
  4. CXR
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3
Q

What methods are there of getting a urine sample from a child?

A

Clean catch
Supra-pubic aspirate
Catheter

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4
Q

What are the signs that a patient is going into septic shock?

A

Hypovolaemia

Low BP, tachycardia, tachypnoea, delayed capillary refill, pallor

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5
Q

What is the diagnosis for these cases?

  1. Meningococcal bacteria grown from blood cultures, CSF clear
  2. Nothing grown from blood cultures, signs of bacterial infection detected in CSF
  3. Meningococcal bacteria grown from blood cultures and signs of bacterial infection detected in CSF
A
  1. Meningococcal septicaemia
  2. Meningitis
  3. Meningococcal sepsis with meningitis
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6
Q

You’re an F1 working in AAU. You receive the results from the LP of a poorly child.

The CSF protein is high, glucose is low, white cell count is high and consists mainly of neutrophils.

What’s the likely pathology?

A

Bacterial meningitis

Remember bacteria use up glucose to reproduce, hence low glucose!

Also CSF is turbid/cloudy

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7
Q

You’re an F1 working in AAU. You receive the results from the LP of a poorly child.

The CSF protein is normal, glucose is normal, white cell count is high and consists mainly of lymphocytes.

What’s the likely pathology?

A

Viral meningitis

Normal glucose, viruses don’t use up glucose? (possibly not true but a good way to remember it)

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8
Q

You’re an F1 working in AAU. You receive the results from the LP of a poorly child.

The CSF protein is increased, glucose is normal, white cell count is raised.

What’s the likely pathology?

A

A sub-arachnoid haemorrhage

The CSF could have frank blood in it or be xanthochromic

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9
Q

What is the immediate management of a very unwell child presenting to A+E?

Talk about both assessment and actions you would undertake.

A

ABCDE approach

A
Assess: is airway patent, can they cry/talk
Action: head tilt-chin lift, jaw thrust, remove blockage, high flow oxygen

B
Assess: cyanosis, o2 stats, respiratory distress, rate, auscultation etc.
Action: ventilate, intubate

C
Assess: pulse, colour, BP, cap refill
Action: cannulate (bloods out, fluid bolus in)

D
Assess: AVPU, pupils, meningism, GCS, DEFglucose

E
Assess: head-to-toe trauma, wounds, bleeding etc, temperature
Action: maintain body temp

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10
Q

What is AVPU?

A

A quick way to assess a person’s level of consciousness

A: awake
V: responds to voice
P: responds to pain
U: unresponsive

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11
Q

What is the sepsis six?

A

Guidance on managing a child with sepsis

  1. High flow oxygen
  2. IV access (take blood)
  3. IV antibiotics
  4. IV fluid bolus
  5. Ensure senior doctor attends
  6. ICU + inotropic support (adrenaline, dopamine)
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12
Q

What is the point of inotropic support in septic children?

What does inotropic support involve?

A

Uses drugs that stimulate the sympathetic nervous system (adrenaline, dopamine)

Thus increasing cardiac output and constricting blood vessels (keeping BP from dropping)

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13
Q

What is purpura? (pathophysiology is a different question)

What are the names of the different sizes of purpura?

A

Purple-ish discolouration of the skin.

Small spots: petechiae
Bigger: purpura
Large areas: ecchymosis

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14
Q

What’s the pathophysiology of purpura?

A

Disseminated intravascular coagulation (DIC)

Bacteraemia causes widespread thrombosis in microvasculature. The platelets are used up and the liver can’t produce enough clotting factors, so bleeding occurs which leaks into skin

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15
Q

What’s the bug that’s responsible for meningococcal septicaemia?

How is it spread?

A

Neisseria meningitides

Respiratory secretions, but only spreads in very close or lengthy contact

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16
Q

Which contacts of a patient with meningitis should receive prophylaxis?

A

People living in the same house, boy/girlfriends, in direct contact with patient’s oral secretions

17
Q

What drugs are used for prophylaxis of contacts of a meningitis patient?

What info do you need to give them?

A

Rifampicin, ciprofloxacin

Rifampicin stains urine orange and it interacts with the OCP

18
Q

Which meningitides are currently vaccinated against?

A

Men B in infants

Men AWXY in adolescents

19
Q

Which are the two common bugs that cause UTIs in children?

A

E coli

Klebsiella

20
Q

What’s the first line antibiotic used to treat UTI in children?

Give two other 2nd line ones

A

Trimethoprim

Amoxicillin
Nitrofurantoin

21
Q

What antibiotics should you prescribe for an infant with meningitis?

A

Cefotaxime (used in all children)

Plus amoxicillin to cover for listeria

22
Q

A child presents with 3 day history of fever which resolved and then a Maculopapular rash developed. What’s the likely cause? What bug is causing it?

A

Roseola infantum

Often presents with a rash that appears after fever resolves

Herpes virus

23
Q

A 2 month old baby presents with a fever of 38.1 but no other symptoms. Should you admit them to hospital?

A

Yes. All children under 3 months with fever should be admitted

24
Q

A child presents with a fever which is followed by a rash that is that is vesicular (fluid filled). What’s the likely diagnosis? What bug is causing it?

A

Chickenpox

Varicella zoster

25
Q

A child presents with fever, malaise and conjunctivitis.
They have a rash that’s blotchy. You see white spots in their mouth.

What’s the likely diagnosis? What bug is causing it?

A

Measles

Measles virus

26
Q

A child presents with fever, malaise and pain in their ears and jaw when eating.

What’s the likely diagnosis? What bug is causing it?

A

Mumps

Mumps virus

27
Q

A child presents with red cheeks, malaise and fever.

What’s the likely diagnosis? What bug is causing it?

A

Slapped cheek

Parvovirus B19

28
Q

A child presents with fever, tonsillitis, bright red tongue. They have a rash on their body but not face.

What’s the likely diagnosis? What bug is causing it?

A

Scarlet Fever

Group A strep

29
Q

A child presents with malaise, fever and vesicular rash around the mouth, hands and feet.

What’s the likely diagnosis? What bug is causing it?

A

Hand, foot and mouth

Coxsackie A16

30
Q

What antibiotic would you give immediately to a septic looking child?

A

IV cefotaxime

31
Q

What ages can you give cefotaxime or ceftriaxone?

A

Cefotaxime - all

Ceftriaxone - not under 3 months

32
Q

How do cephalosporins work?

A

M

33
Q

What antibiotics would you give as prophylaxis for a UTI?

What about for just a UTI?

A

Amoxicillin
Trimethoprim

Trimethoprim first line, amoxicillin second.

34
Q

How does trimethoprim work?

A

Blocks folate metabolism in bacteria causing their death

35
Q

How does amoxicillin work?

A

Beta lactamase

Inhibits cross linking in cell wall so bacteria breaks down!

36
Q

Management of DKA?

A 
Normal saline bolus + fluid replacement
Insulin (after 1-2hrs)
K replacement
Antibiotics
HCO bicarbonates
37
Q

Why can’t you give normal fluid bolus to DKA patient?

A

Cerebral oedema

38
Q

Clinical features of DKA?

A

Diuresis, delirium, dizziness, dehydration

Ketoic breath, kussmal respirations (deep laboured breathing)

Abdo pain

GP (13 decks)

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