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3 Child health EJR > week 1 > Flashcards

week 1 Flashcards

1
Q

what does BINDS stand for in paeds hx taking

A 
birth
immunisation
nutrition
development
social
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2
Q

what are the 4 domains in development

A

gross motor
fine motor and vision
speech and language
social and emotional

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3
Q

what to ask in birth hx

A

antenatal
perinatal
neonatal

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4
Q

what to ask for in social circumstances

A

siblings
parents
relationships
jobs

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5
Q

what does HEADSS stand for in adolescent history

A 
home
education
activities
drugs/alcohol
sexuality
suicide/depression/mood
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6
Q

how to do BLS in children

A

DRS ABC

airway - don’t hyperextend
breathing - give 5 rescue breaths after assessing that child is not breathing
circulation - 15 compression 2 breaths

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7
Q

4Hs and 4Ts of causes of cardiac arrest

A

hyperkalaemia/natraemia etc
hypoxia
hypothermia
hypovolaemia

tamponade
toxins
thrombus
tension pneumothorax

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8
Q

why do you start with 5 rescue breaths in children BLS

A

because children are more likely to arrest due to respiratory failure

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9
Q

in an emergency setting, what to assess for in ABCDE approach

A

airways - any foreign body, head tilt chin lift, adjunct PRN
breathing - expansion, sounds, recessions, cyanosis, (effort, efficacy, effects), RR, o2 sats
circulation - heart rate, CRT, skin, urine, BP
disability - AVPU, BM, pupils,
exposure - bleeding/fractures/trauma

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10
Q

in an emergency setting what can be administered in the ABCDE approach

A

airway - position,adjuncts, tubes, intubation
breathing - o2 mask, nasal cannula, bvm, drugs
circulation - cpr, drugs, IV fluids

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11
Q

indications for IVT in children

A 
shock
dehydration
pre-operative (NBM)
unable to tolerate fluids
bleeding
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12
Q

considerations for IVT

A

shock/dehydration status (compensate for losses)
nutrition status
cardiac/renal status

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13
Q

what types of fluids are there

A

crystalloids

colloids

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14
Q

what is the fluid of choice for basic maintenance fluid

A

0.9% sodium chloride + 5% dextrose (mixed or alternate)

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15
Q

what is different about colloids from crystalloids

A

addition of proteins which can increase oncotic pressures

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16
Q

hartmann’s solution is used extensively in paediatrics - T or false

A

false, not used often in paeds because of high potassium and low dextrose

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17
Q

how to calculate volume required for maintenence fluids

A

100ml/kg for 1st 10kg
50ml/kg for next 10 kg
20ml/kg for everything after 20kg

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18
Q

what is the fluid requirement for shock

A

bolus of 0.9% saline - STAT

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19
Q

how to calculate volume required for shock treatment

A

20ml/kg

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20
Q

BP RR HR, which goes first in paediatric shock?

A

RR, then HR then BP

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21
Q

what cases of shock do you reduce the volume required for the bolus of IV fluid

A

trauma, cardiac, renal failure

10ml/kg

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22
Q

what are the 3 volumes of calculations required in IVT for paediatrics

A

1) maintenence fluids
2) +/- shock
3) added 24hr requirement if patient presented in shock or dehydration

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23
Q

how to calculate added IVT requirements if patient presented in shock or dehydration

A

shock - add 100ml/kg for the 24hr period

dehydration - add 50ml/kg for 24hr period

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24
Q

what to do after prescription of IVT

A

reassess after every bag

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25
Q

development stage at 3 months - gross motor

A

head lag pull to sit
prone: hip and knee extensions
walking reflex
prone: head/neck extension

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26
Q

development stage at 3 months - fine motor

A

two hand midline grasp
tracking eyes
palmar reflex waning

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27
Q

development stage at 3 months - social/emotional

A

social smile

-ve stranger anxiety

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28
Q

development stage at 3 months - speech and hearing

A

coos/babble

quietens to nice sounds

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29
Q

development stage at 6 months - gross motor

A

sit with support
pull to sit - head midline
neck control and head movement

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30
Q

development stage at 6 months - fine motor

A

palmar grasp
transfer
reaches for objects

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31
Q

development stage at 9 months - gross motor

A 
sit unsupport
crawl
prone: push off floor
weight bear with support
crusing
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32
Q

development stage at 9 months - fine motor

A

pyramid grip
object permanency
slight stranger anxiety

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33
Q

development stage at 12 months - gross motor

A

walking

cruising

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34
Q

development stage at 12 months - fine motor

A

pincer grip

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35
Q

other developmenta milestones above 1 year old

A

stacking cubes, talking in longer sentences, playing with self -> playing with friends, walking confidently, echolalia

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36
Q

common presentions of cystic fibrosis

A

neonatal screening
neonatal meconium ileus

recurrent chest infections
malabsorption
failure to thrive
abdominal distension
cough/wheeze
loose/offensive stools
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37
Q

cardinal symptoms of CF

A

failure to thrive
loose/offensive stools (steatorrhea)
recurrent chest infection

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38
Q

differential diagnosis for CF

A 
coeliacs disease
(abdominal distension and weight loss)
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39
Q

investigations for CF

A

sweat testing

serum immunoreative trypsin

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40
Q

treatment for CF

A

chest physio
antibiotics
bronchodilators
lung transplant

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41
Q

signs of paediatric respiratory distress

A 
nasal flaring
tachypnea
recessions
head bobbing
seesaw breathing
grunting
wheeze/stridor
low O2 sats
cyanosis
altered mental state
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42
Q

pathophysiology of CF

A

mutation in gene that makes the CFTR protein results in faulty chloride ion secretion which then impedes water secretion. this leads to low water content in lung secretions and thick mucus.

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43
Q

common presentation of CF

A 
neonatal screening
meconium ileus
recurrent respiratory infections
steatorrhoea
clubbing
bloating with malabsorption
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44
Q

investigation for CF

A

sweat testing

serum immunoreactive trypsin

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45
Q

management of CF

A

prophylactic antibiotics
digestive enzymes

bronchodilators
nebulised mucolytics

chest physio
frequent reviews

family and school education/support plans

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46
Q

long term complications of CF

A

lung failure
DM
male infertility
portal hypertension

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47
Q

3 common things that can cause wheezing in children

A

VIW
multiple-trigger wheeze
asthma

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48
Q

causes of asthma

A

genetic predisposition
atopy
environmental triggers like URTI, allergens, smoke, cold air

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49
Q

common triggers of asthma attacks

A 
emotion
exercise
cold air
allergens
infection
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50
Q

clinical features of an asthma attack

A

wheeze
dyspnea
coughing

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51
Q

how to determine severity of asthma from history

A 
frequency of attacks
timing of attacks
triggers
frequency of inhaler use - number of puffs
types of inhaler used
any hospital admissions
steroid use
other allergies/atopy - anaphylaxis/eczema etc
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52
Q

investigations in asthma

A

blood antibody testing
sking prick test
spirometry
PEF meter

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53
Q

acute management of asthma

A

O SHIT ME

oyxgen
salbutamol
hydrocortisone
ipratripium bromide
theophylline
magnesium
escalate care
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54
Q

long term management of asthma

A

blue inhaler - salbutamol
brown inhaler - steroid inhaler
purple inhaler - seratide (steroid + LABA)

volumetric technique

PEFR diary

regular reviews

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55
Q

cause of GOR in infants

A

immaturity of lower esophageal sphincter

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56
Q

complications of GOR in infants

A

failure to thrive
oesophagitis
recurrent pulmonary aspiration

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57
Q

management of GOR

A

thickening agent
advise on more upright feeding position

PPI
ranitidine
domperidone
surgical management - nissen fundoplication

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58
Q

causes/risk factors of recurrent chest infections in children

A 
CF
bronchiecstasis
foreign body airway obstruction
immunocompromise
airway anatomicaly abnormality
lak of breast feeding
malnutrition
passive tobacco smoke inhalation
asthma
air pollution
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59
Q

vomiting in children - causes

A 
GOR
gastroenteritis
UTI/URTI/Infection
intestinal obstructions
dietary protein intolerance
meningitis

testicular torsion
coeliacs
raised ICP

DKA
pregnancy
alcohol drugs

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60
Q

red flags of vomiting in children

A 
bile stained vomit
haematemesis
projectile vomiting
peritonism
dehydration/shock
61
Q

what causes croup

A

viral infection of URT, causing inflammation of larynx and trachea

62
Q

difference between croup and VIW

A

VIW is just a cold, caused by the common cold virus, that causes a wheeze in younger children who have smaller airways

croup is similar but involves the larynx and trachea which gives it the characteristics barking cough

63
Q

symptoms of croup

A

barking cough, stridor, harsh cry

coryzal symptoms

64
Q

treatment of croup

A

usually conservatively but if severe treat as respiratory distress with oral/nebulised steroids

65
Q

differentials of croup

A

epiglottitis
airway foreign body
bacterial tracheitis

66
Q

symptoms of pneumonia

A 
increased work of breathing
fever
poor feeds
anuria
agitation
vomiting after cough
pains (non-specific in young)
67
Q

signs of pneumonia

A 
wheeze
crepitations
ronchi
cyanosis
tachypnea
respiratory distress
cough
68
Q

investigations of pneumonia

A

chest exam
CXR
blood cultures/FBC/CRP

69
Q

differentials of pneumonia

A 
bronchiolitis
asthma
bronchiectasis
heart fialure
gord
foreign body airway obstruction
70
Q

acute management of pneumonia

A

ABCDE

antibiotics

71
Q

how to differentiate viral and bacterial pneumonia

A

viral commonly have URTI symptoms (coryzal)

less toxic signs

72
Q

what is bronchiolitis

A

a severe respiratory infection in infants, most commonly due to RSV or rhinovirus. affects the bronchioles but can spread to become pneumonia

73
Q

symptoms of bronchiolitis

A 
coryzal symptoms
fever
increased work of breathing
cough
respiratory distress in severe cases
74
Q

signs of bronchiolitis

A 
tachypnea
wheeze
recessions
cough
crackles
hypoxemia
75
Q

differentials of bronchiolitis

A 
VIW
pneumonia
foreign body airway obstruction
CHD
heart failure
76
Q

most common causative organism of croup?

A

parainfluenzae virus

77
Q

Examples of left to right shunting CHDs

A

ASD
VSD
PDA

78
Q

Examples of right to left shunting CHDs

A

tetralogy of fallot

transposition of great arteries

79
Q

examples of common mixing CHDs

A

AVSD (complete)

80
Q

examples of outflow obstruction in well child

A

aortic and pulmonary stenosis

81
Q

examples of outflow obstruction in unwell child

A

coarctation of the aorta

82
Q

changes in fetal and neonate circulation

A

first breath causes left pressure to increase over right.

closes foramen ovale and ductus arteriosus

83
Q

causes of CHD

A

maternal drugs/infection

genetic/chromosomal abnormalities

84
Q

example of maternal medication that can cause a CHD

A

warfarin

85
Q

what are features of an innocent heart murmur in a child

A

symptompless
soft
sternal left edge
systolic murmur

86
Q

what to do if a murmur is found in a newborn

A

escalate

investigate - cxr echo ecg

87
Q

symptoms of heart failure in children

A 
weight faltering
breathlessness
poor feeding
sweating
recurrent chest infections
88
Q

causes of heart failure in children

A

obstructed systemic circulation

high pulmonary blood flow

rheumatic heart disease
cardiomyopathy

89
Q

presentation of left to right shunting CHDs

A

breathless
murmur
poor feeding

90
Q

why is there breathlessness in left to right shunting CHDs

A

increased blood flow to right heart causes increase blood flow to the lungs, causing pulmonary edema

91
Q

what type of CHD is a PDA

A

left to right shunting

92
Q

signs of PDA

A

continuous murmurm beneath left clavicle which radiates to the back

93
Q

4 features of tetralogy of fallot

A

overriding aorta
high VSD
hypertrophic right ventricle
pulmonary stenosis

94
Q

what kind of presentation would ToF show?

A

cyanotic

95
Q

is ToF right or left shunting

A

right to left

96
Q

explain why ToF shunts the way it does

A

pulmonary stenosis causes increased right heart pressure, allowing blood to flow through the VSD to the left heart.

97
Q

what is the management for transposition of the great arteries

A

prostaglandin to keep the duct open

balloon catheter to keep the foramen ovale open

surgery

98
Q

what CHD is commonly seen in Down’s syndrome

A

complete AVSD

99
Q

presentation type for complete AVSD

A

blue and breathless

100
Q

presentation of critical aortic and pulmonary stenosis

A

severe heart failure and shock - duct dependent

101
Q

presentation and signs of coarctation of the aorta

A

severe HF, lactic acidosis - metabolic acidosis

weak femoral pulses

102
Q

what is Eisenmenger syndrome

A

permantely raised pulmonary vacular resistance due to prolonged left to right shunting CHD, causing a reverse in septal flow, causing right to left shunting, causing cyanosis

103
Q

what are most anaphylactic reactions caused by

A

food allergy - IgE mediated

104
Q

which age range is anaphylaxis most prevelant

A

<5 year olds

105
Q

acute management of anaphylaxis

A

adrenaline IM

106
Q

symptoms of acute anaphylaxis

A

airway swelling, hoarsness, stridor

tachypnea, wheeze, cyanosis, low sats

poor circulation - shock symptoms

+/- angioedema/urticaria

107
Q

management of acute anaphylaxis

A

Airway management
O2
IV - shock IVT
antihistamine (chlorpheniramine)

hydrocortisone

+/- salbutamol

108
Q

cause of pyloric stenosis

A

pyloric muscle hypertrophy obstructing outlet

109
Q

most common presentation for pyloric stenosis (age, gender)

A

2-8 weeks after birth
boys > girls (4:1)
some family history
firstborn

110
Q

clinical features and signs of pyloric stenosis

A

dehydration
projectile vomiting
weight loss

on test feeds - pyloric mass RUQ
low plasma sodium, potassium and chloride

111
Q

what electrolyte imbalances are present in pyloric stenosis

A

low sodium, potassium and chloride

112
Q

management of pyloric stenosis

A

correction of fluid and electrolyte imbalances

surgery

113
Q

what is an intussusception

A

invagination of a segment of the intestine into itself, usually proximal to distal end.

114
Q

clinical features of an intussusception

A 
paroxysmal severe pain
pallor
poor appetite
\+/- billous vomiting depending on site
palpable sausage shape in abdomen
red currant stool - blood stained mucus
abdominal distension
bowel perforation
115
Q

what is a red currant stool a sign of?

A

intussusception

116
Q

what is rectal air insufflation a management option for?

A

intussusception

117
Q

how to investigate possible intussusception

A

AXR with contrast

ulrasound

118
Q

presentation of a child with malrotation

A

dark green vomit
abdominal pain
peritonitis
ischaemic bowel signs - shock

119
Q

what is hirschsprung disease

A

absence of ganglion cells and adequate innervation in colon, usually rectosigmoid. leads to constricted and narrowed distal colon

120
Q

presentation of hirshsprung disease

A

usually neonate

failure to pass meconium in first 24 hours
intestinal obstruction
abdominal distension
bile stained vomit

121
Q

what will a PR on a child with hirshsprung disease do

A

release gush of liquid stool and flatulence

might delay diagnosis

122
Q

symptoms of appendicitis

A

anorexia
vomiting
abdomen pain

123
Q

description of abdomen pain characteristic of appendicitis

A

umbilical pain moving to RIF

124
Q

signs of appendicitis

A

fever
abdominal pain worse on moving
tenderness with guarding RIF

125
Q

investigation for appendicitis

A

bloods, USS, exploratory laparoscopy

126
Q

what are some organ dysfunctions trisomy 21, down’s syndrome is associated with?

A 
heart - septal defects
GI - duodenal atresia
blood - acute lymphoblastic leukaemia
brain - mental retardation, ahlzeimer's disease
reproductive - sterility in males
127
Q

what are 4 blood markers that can be measure during pregnancy to assess risk of down’s syndrome

A

reduced alfa-fetoprotein
reduced unconjugated estriol (uE3)
increased HCG
increasd inhibin A

128
Q

4 physical features of down’s syndrome

A

flat face profile
simian fold on palm
epicanthal fold
sandal gap deformity

129
Q

what murmur is heard in a VSD?

A

pansystolic murmur

130
Q

what murmur is heard in ASD?

A

mid-systolic murmur with split S2

131
Q

what murmur is heard in PDA?

A

continuous murmur

132
Q

what congenital heard defects are right to left shunting?

A

transposition of the great arteries and tetralogy of fallot,

133
Q

what congenital heart defect can cause a differential cyanosis? (what is differential cyanosis?)

A

patent ductus arteriosus with eisenmenger syndrome -> cyanosis in lower half of the body

134
Q

what congenital heart defects are emergency cases after birth? (duct dependent)

A 
transposition of the great arteries
AVSD
tetralogy of Fallot
coarctation of the aorta
critical stenosis of pulmonary or aortic arteries
135
Q

presentation of testicular torsion

A

acute onset pain in groin, lower abdomen, or scrotum with swelling and redness

136
Q

presentation of idiopathic thrombocytopaenia purpura?

A

children 2-10 years old, 1-2 weeks after viral illness, present with bruising, or persistent bleeding somewhere.

137
Q

definition of thrombocytopaenia?

A

platelet <150 x10^9/L

138
Q

cause of ITP ?

A

autoimmune, antibodies made against platelets

139
Q

diagnosis of ITP?

A

diagnosis of exclusion, BM biopsy if other blood abnormalities, otherwise, no need.

140
Q

treatment for ITP?

A

usually self-limiting in 6-8weeks.

if treatment is imperative, then use oral prednisolone, or anti-D or immunoglobulins

141
Q

what are 5 features of HSP

A 
rash
swollen joints
painful joints
abdominal pain
nephritis/haematuriea
142
Q

what is the typical characteristics of someone presenting with HSP

A

child 3-10 y/o
preceded by URTI
peaks in winter

143
Q

what causes HSP

A

possibly immune complex deposition in joints/kidney/vessels

144
Q

clinical features of HSP

A 
low grade fever
rash - symmetrical over extensor surfaces, arms, legs, ankles, buttocks
joint pain
periarticular edema
renal involvement
colicky abdominal pain
145
Q

what is abdominal pain in HSP treated with

A

steroids

146
Q

what can renal involvement in HSP progress to?

A

microscopic/macroscopic haematuria, nephrotic syndrome

147
Q

investigations for suspected HSP?

A 
urine microscopy and culture
U&amp;E + protein + calcium excretion
serum calcium, phosphate, albumin
FBC, coagulation, sickle cell screen
auto antibody screen

US KUB and abdomen

148
Q

differentials for HSP

A

ITP
intussusception
other causes of glomerulonephritis

149
Q

treatment for HSP

A

usually self limiting, NSAIDs/analgesia, steroids for nephropathy or arthralgia

3 Child health EJR (3 decks)

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