week 1 Flashcards
what does BINDS stand for in paeds hx taking
birth immunisation nutrition development social
what are the 4 domains in development
gross motor
fine motor and vision
speech and language
social and emotional
what to ask in birth hx
antenatal
perinatal
neonatal
what to ask for in social circumstances
siblings
parents
relationships
jobs
what does HEADSS stand for in adolescent history
home education activities drugs/alcohol sexuality suicide/depression/mood
how to do BLS in children
DRS ABC
airway - don’t hyperextend
breathing - give 5 rescue breaths after assessing that child is not breathing
circulation - 15 compression 2 breaths
4Hs and 4Ts of causes of cardiac arrest
hyperkalaemia/natraemia etc
hypoxia
hypothermia
hypovolaemia
tamponade
toxins
thrombus
tension pneumothorax
why do you start with 5 rescue breaths in children BLS
because children are more likely to arrest due to respiratory failure
in an emergency setting, what to assess for in ABCDE approach
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
in an emergency setting what can be administered in the ABCDE approach
airway - position,adjuncts, tubes, intubation
breathing - o2 mask, nasal cannula, bvm, drugs
circulation - cpr, drugs, IV fluids
indications for IVT in children
shock dehydration pre-operative (NBM) unable to tolerate fluids bleeding
considerations for IVT
shock/dehydration status (compensate for losses)
nutrition status
cardiac/renal status
what types of fluids are there
crystalloids
colloids
what is the fluid of choice for basic maintenance fluid
0.9% sodium chloride + 5% dextrose (mixed or alternate)
what is different about colloids from crystalloids
addition of proteins which can increase oncotic pressures
hartmann’s solution is used extensively in paediatrics - T or false
false, not used often in paeds because of high potassium and low dextrose
how to calculate volume required for maintenence fluids
100ml/kg for 1st 10kg
50ml/kg for next 10 kg
20ml/kg for everything after 20kg
what is the fluid requirement for shock
bolus of 0.9% saline - STAT
how to calculate volume required for shock treatment
20ml/kg
BP RR HR, which goes first in paediatric shock?
RR, then HR then BP
what cases of shock do you reduce the volume required for the bolus of IV fluid
trauma, cardiac, renal failure
10ml/kg
what are the 3 volumes of calculations required in IVT for paediatrics
1) maintenence fluids
2) +/- shock
3) added 24hr requirement if patient presented in shock or dehydration
how to calculate added IVT requirements if patient presented in shock or dehydration
shock - add 100ml/kg for the 24hr period
dehydration - add 50ml/kg for 24hr period
what to do after prescription of IVT
reassess after every bag
development stage at 3 months - gross motor
head lag pull to sit
prone: hip and knee extensions
walking reflex
prone: head/neck extension
development stage at 3 months - fine motor
two hand midline grasp
tracking eyes
palmar reflex waning
development stage at 3 months - social/emotional
social smile
-ve stranger anxiety
development stage at 3 months - speech and hearing
coos/babble
quietens to nice sounds
development stage at 6 months - gross motor
sit with support
pull to sit - head midline
neck control and head movement
development stage at 6 months - fine motor
palmar grasp
transfer
reaches for objects
development stage at 9 months - gross motor
sit unsupport crawl prone: push off floor weight bear with support crusing
development stage at 9 months - fine motor
pyramid grip
object permanency
slight stranger anxiety
development stage at 12 months - gross motor
walking
cruising
development stage at 12 months - fine motor
pincer grip
other developmenta milestones above 1 year old
stacking cubes, talking in longer sentences, playing with self -> playing with friends, walking confidently, echolalia
common presentions of cystic fibrosis
neonatal screening
neonatal meconium ileus
recurrent chest infections malabsorption failure to thrive abdominal distension cough/wheeze loose/offensive stools
cardinal symptoms of CF
failure to thrive
loose/offensive stools (steatorrhea)
recurrent chest infection
differential diagnosis for CF
coeliacs disease (abdominal distension and weight loss)
investigations for CF
sweat testing
serum immunoreative trypsin
treatment for CF
chest physio
antibiotics
bronchodilators
lung transplant
signs of paediatric respiratory distress
nasal flaring tachypnea recessions head bobbing seesaw breathing grunting wheeze/stridor low O2 sats cyanosis altered mental state
pathophysiology of CF
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.
common presentation of CF
neonatal screening meconium ileus recurrent respiratory infections steatorrhoea clubbing bloating with malabsorption
investigation for CF
sweat testing
serum immunoreactive trypsin
management of CF
prophylactic antibiotics
digestive enzymes
bronchodilators
nebulised mucolytics
chest physio
frequent reviews
family and school education/support plans
long term complications of CF
lung failure
DM
male infertility
portal hypertension
3 common things that can cause wheezing in children
VIW
multiple-trigger wheeze
asthma
causes of asthma
genetic predisposition
atopy
environmental triggers like URTI, allergens, smoke, cold air
common triggers of asthma attacks
emotion exercise cold air allergens infection
clinical features of an asthma attack
wheeze
dyspnea
coughing
how to determine severity of asthma from history
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
investigations in asthma
blood antibody testing
sking prick test
spirometry
PEF meter
acute management of asthma
O SHIT ME
oyxgen salbutamol hydrocortisone ipratripium bromide theophylline magnesium escalate care
long term management of asthma
blue inhaler - salbutamol
brown inhaler - steroid inhaler
purple inhaler - seratide (steroid + LABA)
volumetric technique
PEFR diary
regular reviews
cause of GOR in infants
immaturity of lower esophageal sphincter
complications of GOR in infants
failure to thrive
oesophagitis
recurrent pulmonary aspiration
management of GOR
thickening agent
advise on more upright feeding position
PPI
ranitidine
domperidone
surgical management - nissen fundoplication
causes/risk factors of recurrent chest infections in children
CF bronchiecstasis foreign body airway obstruction immunocompromise airway anatomicaly abnormality
lak of breast feeding malnutrition passive tobacco smoke inhalation asthma air pollution
vomiting in children - causes
GOR gastroenteritis UTI/URTI/Infection intestinal obstructions dietary protein intolerance meningitis
testicular torsion
coeliacs
raised ICP
DKA
pregnancy
alcohol drugs
red flags of vomiting in children
bile stained vomit haematemesis projectile vomiting peritonism dehydration/shock
what causes croup
viral infection of URT, causing inflammation of larynx and trachea
difference between croup and VIW
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
symptoms of croup
barking cough, stridor, harsh cry
coryzal symptoms
treatment of croup
usually conservatively but if severe treat as respiratory distress with oral/nebulised steroids
differentials of croup
epiglottitis
airway foreign body
bacterial tracheitis
symptoms of pneumonia
increased work of breathing fever poor feeds anuria agitation vomiting after cough pains (non-specific in young)
signs of pneumonia
wheeze crepitations ronchi cyanosis tachypnea respiratory distress cough
investigations of pneumonia
chest exam
CXR
blood cultures/FBC/CRP
differentials of pneumonia
bronchiolitis asthma bronchiectasis heart fialure gord foreign body airway obstruction
acute management of pneumonia
ABCDE
antibiotics
how to differentiate viral and bacterial pneumonia
viral commonly have URTI symptoms (coryzal)
less toxic signs
what is bronchiolitis
a severe respiratory infection in infants, most commonly due to RSV or rhinovirus. affects the bronchioles but can spread to become pneumonia
symptoms of bronchiolitis
coryzal symptoms fever increased work of breathing cough respiratory distress in severe cases
signs of bronchiolitis
tachypnea wheeze recessions cough crackles hypoxemia
differentials of bronchiolitis
VIW pneumonia foreign body airway obstruction CHD heart failure
most common causative organism of croup?
parainfluenzae virus
Examples of left to right shunting CHDs
ASD
VSD
PDA
Examples of right to left shunting CHDs
tetralogy of fallot
transposition of great arteries
examples of common mixing CHDs
AVSD (complete)
examples of outflow obstruction in well child
aortic and pulmonary stenosis
examples of outflow obstruction in unwell child
coarctation of the aorta
changes in fetal and neonate circulation
first breath causes left pressure to increase over right.
closes foramen ovale and ductus arteriosus
causes of CHD
maternal drugs/infection
genetic/chromosomal abnormalities
example of maternal medication that can cause a CHD
warfarin
what are features of an innocent heart murmur in a child
symptompless
soft
sternal left edge
systolic murmur
what to do if a murmur is found in a newborn
escalate
investigate - cxr echo ecg
symptoms of heart failure in children
weight faltering breathlessness poor feeding sweating recurrent chest infections
causes of heart failure in children
obstructed systemic circulation
high pulmonary blood flow
rheumatic heart disease
cardiomyopathy
presentation of left to right shunting CHDs
breathless
murmur
poor feeding
why is there breathlessness in left to right shunting CHDs
increased blood flow to right heart causes increase blood flow to the lungs, causing pulmonary edema
what type of CHD is a PDA
left to right shunting
signs of PDA
continuous murmurm beneath left clavicle which radiates to the back
4 features of tetralogy of fallot
overriding aorta
high VSD
hypertrophic right ventricle
pulmonary stenosis
what kind of presentation would ToF show?
cyanotic
is ToF right or left shunting
right to left
explain why ToF shunts the way it does
pulmonary stenosis causes increased right heart pressure, allowing blood to flow through the VSD to the left heart.
what is the management for transposition of the great arteries
prostaglandin to keep the duct open
balloon catheter to keep the foramen ovale open
surgery
what CHD is commonly seen in Down’s syndrome
complete AVSD
presentation type for complete AVSD
blue and breathless
presentation of critical aortic and pulmonary stenosis
severe heart failure and shock - duct dependent
presentation and signs of coarctation of the aorta
severe HF, lactic acidosis - metabolic acidosis
weak femoral pulses
what is Eisenmenger syndrome
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
what are most anaphylactic reactions caused by
food allergy - IgE mediated
which age range is anaphylaxis most prevelant
<5 year olds
acute management of anaphylaxis
adrenaline IM
symptoms of acute anaphylaxis
airway swelling, hoarsness, stridor
tachypnea, wheeze, cyanosis, low sats
poor circulation - shock symptoms
+/- angioedema/urticaria
management of acute anaphylaxis
Airway management
O2
IV - shock IVT
antihistamine (chlorpheniramine)
hydrocortisone
+/- salbutamol
cause of pyloric stenosis
pyloric muscle hypertrophy obstructing outlet
most common presentation for pyloric stenosis (age, gender)
2-8 weeks after birth
boys > girls (4:1)
some family history
firstborn
clinical features and signs of pyloric stenosis
dehydration
projectile vomiting
weight loss
on test feeds - pyloric mass RUQ
low plasma sodium, potassium and chloride
what electrolyte imbalances are present in pyloric stenosis
low sodium, potassium and chloride
management of pyloric stenosis
correction of fluid and electrolyte imbalances
surgery
what is an intussusception
invagination of a segment of the intestine into itself, usually proximal to distal end.
clinical features of an intussusception
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
what is a red currant stool a sign of?
intussusception
what is rectal air insufflation a management option for?
intussusception
how to investigate possible intussusception
AXR with contrast
ulrasound
presentation of a child with malrotation
dark green vomit
abdominal pain
peritonitis
ischaemic bowel signs - shock
what is hirschsprung disease
absence of ganglion cells and adequate innervation in colon, usually rectosigmoid. leads to constricted and narrowed distal colon
presentation of hirshsprung disease
usually neonate
failure to pass meconium in first 24 hours
intestinal obstruction
abdominal distension
bile stained vomit
what will a PR on a child with hirshsprung disease do
release gush of liquid stool and flatulence
might delay diagnosis
symptoms of appendicitis
anorexia
vomiting
abdomen pain
description of abdomen pain characteristic of appendicitis
umbilical pain moving to RIF
signs of appendicitis
fever
abdominal pain worse on moving
tenderness with guarding RIF
investigation for appendicitis
bloods, USS, exploratory laparoscopy
what are some organ dysfunctions trisomy 21, down’s syndrome is associated with?
heart - septal defects GI - duodenal atresia blood - acute lymphoblastic leukaemia brain - mental retardation, ahlzeimer's disease reproductive - sterility in males
what are 4 blood markers that can be measure during pregnancy to assess risk of down’s syndrome
reduced alfa-fetoprotein
reduced unconjugated estriol (uE3)
increased HCG
increasd inhibin A
4 physical features of down’s syndrome
flat face profile
simian fold on palm
epicanthal fold
sandal gap deformity
what murmur is heard in a VSD?
pansystolic murmur
what murmur is heard in ASD?
mid-systolic murmur with split S2
what murmur is heard in PDA?
continuous murmur
what congenital heard defects are right to left shunting?
transposition of the great arteries and tetralogy of fallot,
what congenital heart defect can cause a differential cyanosis? (what is differential cyanosis?)
patent ductus arteriosus with eisenmenger syndrome -> cyanosis in lower half of the body
what congenital heart defects are emergency cases after birth? (duct dependent)
transposition of the great arteries AVSD tetralogy of Fallot coarctation of the aorta critical stenosis of pulmonary or aortic arteries
presentation of testicular torsion
acute onset pain in groin, lower abdomen, or scrotum with swelling and redness
presentation of idiopathic thrombocytopaenia purpura?
children 2-10 years old, 1-2 weeks after viral illness, present with bruising, or persistent bleeding somewhere.
definition of thrombocytopaenia?
platelet <150 x10^9/L
cause of ITP ?
autoimmune, antibodies made against platelets
diagnosis of ITP?
diagnosis of exclusion, BM biopsy if other blood abnormalities, otherwise, no need.
treatment for ITP?
usually self-limiting in 6-8weeks.
if treatment is imperative, then use oral prednisolone, or anti-D or immunoglobulins
what are 5 features of HSP
rash swollen joints painful joints abdominal pain nephritis/haematuriea
what is the typical characteristics of someone presenting with HSP
child 3-10 y/o
preceded by URTI
peaks in winter
what causes HSP
possibly immune complex deposition in joints/kidney/vessels
clinical features of HSP
low grade fever rash - symmetrical over extensor surfaces, arms, legs, ankles, buttocks joint pain periarticular edema renal involvement colicky abdominal pain
what is abdominal pain in HSP treated with
steroids
what can renal involvement in HSP progress to?
microscopic/macroscopic haematuria, nephrotic syndrome
investigations for suspected HSP?
urine microscopy and culture U&E + protein + calcium excretion serum calcium, phosphate, albumin FBC, coagulation, sickle cell screen auto antibody screen
US KUB and abdomen
differentials for HSP
ITP
intussusception
other causes of glomerulonephritis
treatment for HSP
usually self limiting, NSAIDs/analgesia, steroids for nephropathy or arthralgia
