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Paediatrics 👫👶🏼 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Advise for parents to avoid SUDI

A
  • Back to sleep
  • no smoking
  • breast feeding
  • lie to bottom of cot
  • don’t overwrap
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2
Q

When should an infant be able to social smile

A

6-8 weeks

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3
Q

When should an infant be able to sit steadily without support

A

By 8-9 months

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4
Q

When should a baby be able to walk without help

A

By 18 months

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5
Q

When should an infant be able to start joining words into sentences

A

21-24 months

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6
Q

When would you refer a child for not meeting milestones

A

If not achieved by 2 standard deviations from the mean

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7
Q

What are the adverse antenatal environmental factors that would affect infants meeting milestones

A

Infections (CMV, Rubella, Toxo, VSV);

Toxins (alcohol, smoking, anti-epileptics)

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8
Q

What are the post natal environmental factors that may affect an infant meeting milestones

A 
Infection - meningitis, encephalitis 
Toxins -solvents, mercury, lead 
Trauma 
Malnutrition (iron, folate, Vit D)
Metabolic (hypoglycaemia)
Maltreatment 
Maternal mental health issues
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9
Q

Red flags in development

A 
Loss of developmental skills
Parental/professional concern about vision 
Hearing loss 
Persistent low muscle tone/floppiness
No speech by 18 months
Assymetry of movements 
Not walking by 18 months
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10
Q

How long is milk the exclusive feed for infants

A

4-6 months

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11
Q

Why is breast best

A

Tailor made passive immunity

Increase development of infants gut mucosa

Suckling helps bonding

Reduced infection

Antigen load minimal

Cheap!!

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12
Q

What is the first line feed choice for cows milk protein allergy

A

Extensively hydrolysed protein feeds

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13
Q

When are lactose free milks indicated

A

Lactose intolerance - reduced level of lactase enzyme (can be seen in breast fed baby so she needs lactose free diet also)

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14
Q

When is soya milk indicated

A

Milk allergy when hydrolysed formulae refused

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15
Q

Why is rice milk not advisedd in children under 5

A

All rice contains inorganic arsenic

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16
Q

When should weaning start

A

About 5-6 months if not before

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17
Q

Why wean

A

Milk not enough to meet energy requirements

Digestion and absorption of nutrients from other animals and plants is part of our make-up

Encourage tongue and jaw movements in preparation for speech and social interaction

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18
Q

Who is at risk of low vitamin D

A

Dark skinned children not on vitamin drops

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19
Q

Causes of failure to thrive in early life

A

Deficient intake -

  • maternal - poor lactation, incorrectly prepared feeds, inadequate care
  • infant - prematurity, small for dates, oropalatal abnormalities, neuromuscular disease

Increased metabolic demands

  • congenital lung disease, heart disease, liver disease, renal disease,
  • infection, anaemia, thyroid disease, malignancy

Excessive nutrient loss -
- GORD, pyloric stenosis, gastro-enteritis, malabsorption

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20
Q

Organisms responsible for UTI in children

A

E.coli
Klebsiella
Proteus

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21
Q

Most common presentation in neonates with UTI

A

Fever
Vomiting
Lethargy
Irritability

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22
Q

Common presentation of pre-verbal children with UTI

A

FEVER
Abdo pain or tenderness
Vomiting
Poor feeding

(Lethargy, irritability)

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23
Q

How would you obtain a urine specimen in an infant

A

Clean catch urine/midstream urine specimen recommended

Non-invasive methods - collection pads, urine bags

Catheter samples or suprapubic aspiration with USS guidance in unwell infants

24
Q

Diagnosis of a UTI

A

Dipstix - leucocyte esterase activity, nitrites

Microscopy - pyuria >10 WBC per cubic mm
Bacturia

Culture - takes 48 hours so treat before know

25
Q

How best to image the urinary system

A

Renal uss
DMSA - isotope scan
Micturating cytourethrogram

26
Q

Most common cause of acute renal failure

A

Haemolytic-uraemic syndrome

27
Q

Most common cause of haemolytic uraemic syndrome

A

Post diarrhoea -

  • entero-haemorrhagic E.coli (raised in cattle)
  • shigella
28
Q

Haemolytic uraemic syndrome is a triad of…

A
  • microangiopathic haemolytic anaemia
  • thrombocytopenia
  • acute renal failure
29
Q

Treatment of haemolytic uraemic syndrome

A

Fluid balance, electrolytes, acidosis

NO ANTIBIOTICS

Treat hypertension
Renal replacement therapy

30
Q

Presentation of haemolytic uraemic syndrome in children

A

Bloody diarrhoea

31
Q

Causes of sudden unexplained death in an infant

A
  • infection
  • cardiac cause
  • infanticide
  • metabolic cause
32
Q

Possible diagnosis in a 3 month old bottle fed baby with 4-5 loose stools/day and several vomits/day

A

Cow’s milk protein allergy/intolerance with reflux

33
Q

Management of a baby with milk protein intolerance

A

Trial of hydrolysed feed

34
Q

Diagnosis for healthy baby with good weight gain, breast fed presenting with streaks of fresh blood in stool

A

Cows milk protein allergy

Infection, constipation or surgical cause

35
Q

Management of a breast fed baby with milk protein intolerance

A

Maternal milk avoidance - will need calcium/vit D supplementation and dietician input

36
Q

Symptoms caused by cow’s milk

A

Immune mediated (cow’s milk protein allergy)

  • -> IgE mediated immediate onset
  • -> non-IgE mediated delayed

Lactose intolerance (not an allergy)

37
Q

Outcome of IgE mediated food allergy

A

Reactions within 2 hours of ingestion

Resolution of symptoms within 2 hours

  • GI vomiting/pain/diarrhoea
  • Skin urticaria/angiodema/priritus
  • Resp rhinoconjunctivitis/wheeze/cough/stridor
  • anaphylaxis and collapse
38
Q

Outcome of non-IgE mediated food allergy

A

Delayed - symptoms develop over hours or days

Symptoms may last for many days

Often non-specific/multi-system
- vomiting, diarrhoea, abdo pain, reflux, poor feeding, failure to thrive, eczema

39
Q

When to consider milk challenge in those with milk protein intolerance

A

Where initial symptoms were of eczema, poor weight gain, diarrhoea

Consider around 1 year
- baked milk in biscuit then yoghurt…

40
Q

Outcome of GORD in babies

A

Vast majority remain well and symptoms resolve in infancy with maturation of lower oesophageal sphincter function

41
Q

Treatment of GORD

A

Reassurance (using growth plots)
Feeding technique - smaller more frequent
Positioning - raise head of cot
Milk thickeners
Antacids
Gastric acid secretion (H2 antagonists; PPI)
Fundoplication (rare)

42
Q

Symptoms of coeliac disease

A

Symptoms only occur after intro of cereals into diet during weaning

GI symptoms - loose pale stools, flatus
Variable growth failure/weight gain
May have distended abdomen, less subcut fat and muscle wasting

43
Q

Investigations for coeliac

A

Stool screen
FBC, ion status, CRP, liver,
Coeliac screen (IgA - anti-tissue transglutaminase or anti-endomysial

NEED SMALL BOWEL BIOPSY TO CONFIRM

44
Q

Treatment for coeliac

A

Gluten free diet with dietician input

45
Q

Examination for a child with constipation +/- impaction

A

Inspect lower spine and anus
Check lower limb neurology
Measurements and centile
NO RECTAL EXAM

46
Q

The constipation cycle

A 
Constipation 
-->
Large hard stool 
-->
Pain or anal fissure 
-->
Withholding of stool 
--> const...
47
Q

Treatment of constipation with overflow

A

Stool softeners/stimilants
- senna, lactulose, movicol

Increase fluid intake 
Fruit, veg and fibre 
Reduce milk/sweets 
Toilet routine and comfort 
Praise and star charts
48
Q

Diagnosis and differential for 10 wk old with 4 weeks of frequent post-feed effortless vomits and distress

A

GORD
+/- milk intolerance
Pyloric stenosis
Consider sticture further down

49
Q

Bilous vomiting is due to

A

Intestinal obstruction until proven otherwise

Malrotation 
Intussusception 
Illeus (?sepsis)
Crohn's 
Intestinal atresia (in new borns)
50
Q

Diagnosis for 6 month girl presenting with 3d feve, vomiting, poor feeding, unsettled, having strong smelling urine

A

UTI

LRTI/pneumonia

51
Q

Investigations for suspected UTI

A

Urine dipstix, microscopy and culture

52
Q

Management of lower tract UTI

A

Oral trimethoprim/co-amixoclav

53
Q

Complications of infant UTI

A

Reflux and renal scarring

54
Q

Assessing hydration

A 
Alertness/conscious level 
Fontanel (if present) - sunken or level 
Sunken eyes 
Dry or moist tongue/lips 
Heart rate and resp rate 
Peripheral warmth and coolness 
Skin turgor 
Weight loss/urine output
55
Q

Management of HUS

A

Supportive care

  • good hydration
  • monitor urine output/fluid balance
  • monitor bloods
  • may require dialysis

ANTIBIOTICS NOT INDICATED

NOTIFY PUBLIC HEALTH

56
Q

Likely diagnosis of 9 yr old boy who wets the bed - no fever or abnormal system on investigation

A

Primary nocturnal enuresis

- want to know if dry during day, urgency, fluid consumption and constipation/stool pattern

57
Q

Management of primary nocturnal enuresis

A

Urine dipstick +/- culture, USS for pre/post volumes

Increase daytime fluids

Decrease night fluids

Pads and alarms to train bladder

Consider desmopressin +/- oxybutynin and

Paediatrics 👫👶🏼 (8 decks)

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