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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
How best to image the urinary system
Renal uss DMSA - isotope scan Micturating cytourethrogram
26
Most common cause of acute renal failure
Haemolytic-uraemic syndrome
27
Most common cause of haemolytic uraemic syndrome
Post diarrhoea - - entero-haemorrhagic E.coli (raised in cattle) - shigella
28
Haemolytic uraemic syndrome is a triad of...
- microangiopathic haemolytic anaemia - thrombocytopenia - acute renal failure
29
Treatment of haemolytic uraemic syndrome
Fluid balance, electrolytes, acidosis NO ANTIBIOTICS Treat hypertension Renal replacement therapy
30
Presentation of haemolytic uraemic syndrome in children
Bloody diarrhoea
31
Causes of sudden unexplained death in an infant
- infection - cardiac cause - infanticide - metabolic cause
32
Possible diagnosis in a 3 month old bottle fed baby with 4-5 loose stools/day and several vomits/day
Cow's milk protein allergy/intolerance with reflux
33
Management of a baby with milk protein intolerance
Trial of hydrolysed feed
34
Diagnosis for healthy baby with good weight gain, breast fed presenting with streaks of fresh blood in stool
Cows milk protein allergy | Infection, constipation or surgical cause
35
Management of a breast fed baby with milk protein intolerance
Maternal milk avoidance - will need calcium/vit D supplementation and dietician input
36
Symptoms caused by cow's milk
Immune mediated (cow's milk protein allergy) - -> IgE mediated immediate onset - -> non-IgE mediated delayed Lactose intolerance (not an allergy)
37
Outcome of IgE mediated food allergy
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
Outcome of non-IgE mediated food allergy
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
When to consider milk challenge in those with milk protein intolerance
Where initial symptoms were of eczema, poor weight gain, diarrhoea Consider around 1 year - baked milk in biscuit then yoghurt...
40
Outcome of GORD in babies
Vast majority remain well and symptoms resolve in infancy with maturation of lower oesophageal sphincter function
41
Treatment of GORD
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
Symptoms of coeliac disease
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
Investigations for coeliac
Stool screen FBC, ion status, CRP, liver, Coeliac screen (IgA - anti-tissue transglutaminase or anti-endomysial NEED SMALL BOWEL BIOPSY TO CONFIRM
44
Treatment for coeliac
Gluten free diet with dietician input
45
Examination for a child with constipation +/- impaction
Inspect lower spine and anus Check lower limb neurology Measurements and centile NO RECTAL EXAM
46
The constipation cycle
``` Constipation --> Large hard stool --> Pain or anal fissure --> Withholding of stool --> const... ```
47
Treatment of constipation with overflow
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
Diagnosis and differential for 10 wk old with 4 weeks of frequent post-feed effortless vomits and distress
GORD +/- milk intolerance Pyloric stenosis Consider sticture further down
49
Bilous vomiting is due to
Intestinal obstruction until proven otherwise ``` Malrotation Intussusception Illeus (?sepsis) Crohn's Intestinal atresia (in new borns) ```
50
Diagnosis for 6 month girl presenting with 3d feve, vomiting, poor feeding, unsettled, having strong smelling urine
UTI | LRTI/pneumonia
51
Investigations for suspected UTI
Urine dipstix, microscopy and culture
52
Management of lower tract UTI
Oral trimethoprim/co-amixoclav
53
Complications of infant UTI
Reflux and renal scarring
54
Assessing hydration
``` 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
Management of HUS
Supportive care - good hydration - monitor urine output/fluid balance - monitor bloods - may require dialysis ANTIBIOTICS NOT INDICATED NOTIFY PUBLIC HEALTH
56
Likely diagnosis of 9 yr old boy who wets the bed - no fever or abnormal system on investigation
Primary nocturnal enuresis | - want to know if dry during day, urgency, fluid consumption and constipation/stool pattern
57
Management of primary nocturnal enuresis
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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