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Y4 Paedatric Survival Guide Flashcards

1
Q

Define neonate

A

Birth to 28 days

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2
Q

Define toddler

A

1-2 years

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3
Q

Define child

A

2-12 years

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4
Q

Define adolescent

A

12-18 years

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5
Q

Before carrying out an examination of a newborn what questions do you want to ask the mother?

A

Was birthweight normal?
Was birth and pregnancy normal?
Is mother rh-ve?

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6
Q

What scoring system is used to assess the health of a newborn?

A

Apgar
Used at 1, 5 and 10 minutes after delivery
Used as a tool to see if baby needs extra respiratory/CV support

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7
Q

What is the Apgar scoring system?

A

Use picture

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8
Q

What is involved in routine examination of the newborn?

A

Height, wt, OFC
Complexion (jaundice, pale, cyanosed)
Fontanelles
Eyes (red reflex, cataracts, retinoblastoma)
Ears (patent, mobile, positioning)
Mouth (palate, suck reflex)
Upper limb (fingers present & mobile, grasp reflex, single palmar crease, Erb’s palsy)
Chest (HS & respiration (grunting, intercostal recessions))
Abdomen (distension, masses, anal patency)
Femoral pulses, brachio-femoral delay
HIp (Barlow’s & Otolenghi’s tests for DDH)
Genital (testicular descent, hypospadias)
Lower limb (talipes, toes present & mobile)
Back (spina bifida)
Primitive reflexes

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9
Q

Why might fontanelles be sunken in a newborn?

A

Dehydration

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10
Q

Why might fontanelles be tense in a newborn?

A

Crying

Increased intracranial pressure

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11
Q

What is the 50th centile for OFC in a newborn?

A

35cm

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12
Q

What can PV bleeding in the neonate be due to?

A

May be normal variant after coming off maternal oestrogen

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13
Q

What must you ensure the baby does in the first 24h of life?

A

Passes urine and stool

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14
Q

Failure to pass urine in a neonate may indicate what?

A

Posterior urethral valves in boys

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15
Q

Failure to pass meconium in a neonate may indicate what?

A

Hirschprung’s
CF
Hypothyroidism

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16
Q

What sign may be suggestive of spinda bifida occulta in a newborn?

A

Tufts of hair and simples

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17
Q

How can you elicit a grasp reflex in a newborn?

A

Stroke the palm

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18
Q

What is the Moro reflex?

A

Hold baby at 45 degrees supporting the head

Drop them momentarily and watch for hands to open and arms to abduct

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19
Q

What may a jittery neonate indicate?

A

Hypoxia/ischaemia, encephalopathy, hypoglycaemia, infection, hypocalcaemia

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20
Q

What may absence of primitive reflexes in a neonate indicate?

A

Problem in spinal cord

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21
Q

What might failure of primitive reflexes to disappear indicate?

A

Slow development of cortical control of movement

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22
Q

What is rooting?

A

Turning of head towards finger when stroked on cheek

Response to looking for feeds

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23
Q

What is the sucking reflex?

A

Baby sucks when gloved finger inserted into mouth

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24
Q

What is the asymmetrical tonic neck reflex?

A

Turns baby’s head to one side and arms/legs should extend on same side

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25
What is the symmetrical tonic neck reflex?
Flex baby's head forward and arms/legs should extend (opposite when baby's head is extended)
26
What is the doll's eye reflex?
When baby's head manually turned, eyes will stay fixed instead of moving with the head
27
What is the Gurthrie test?
Taken on day 5 Heel prick test for PKU, hypothyroidism, sickle cell disease, CF, MCACDD, galactosaemia, maple syrup urine disease, homocystinuria and 2 other metabolic diseases
28
Define prematurity
<37 weeks gestation | Extreme prematurity <28 weeks
29
What complications are premature babies at risk of?
RDS, sepsis, IVH, PDA, NEC, RoP
30
Define low birth weight
<2.5kg
31
Define v. low birth weight
<1.5kg
32
Define extremely low birth weight
<1kg
33
What causes low birth weight
Placental insufficiency --> IUGR (e.g. pre-eclampsia, DM, smoking, alcohol, maternal dx, multiple gestation) Foetal factors, e.g. congenital infections (ToRCH) - usually symmetric growth retardation
34
What is HIE?
Neonatal brain injury secondary to hypoxia
35
What are the clinical findings of HIE?
CNS (mild HIE - hyperalert, hypotonia, severe HIE –stuporose/comatose, seizures), Other organ damage including kidney, cardiovascular and haematological disturbances
36
How do you diagnose HIE?
EEG shoes marked voltage suppression or isoelectric (flat)
37
How do you manage HIE?
Cooling, supportive Rx
38
What is the prognosis of HIE?
depends on severity. Mild or moderate most do well with disability in about 25%. Severe – half die in the neonatal period, 25% Cerebral Palsy, Epilepsy, Blindness, Deafness, Learning difficulties and Behaviour problems
39
Define hypoglycaemia in the newborn
BG <2.6
40
What are the aetiologies of neonatal hypoglycaemia?
``` Normal (glucose drops in first few hrs of life) Gestational diabetes Prematurity Hypothermia Infection Breathing difficulties at birth ```
41
What are the clinical features of neonatal hypoglycaemia?
Irritability, sleepiness, floppiness, seizures, apnoea, hunger, vomiting
42
How do you manage neonatal hypoglycaemia?
Breast feeding/expressed milk or formula milk, maintain skin to skin contact (encourages feeds), NG/IV dextrose/glucagon/octreotide
43
What is meconium aspiration syndrome?
Pneumonitis due to aspiration of meconium before or during delivery (often due to foetal distress/hypoxia)
44
What are the clinical features of meconium aspiration syndrome?
Green/yellow amniotic fluid, meconium staining of neonate (skin, nails etc.), respiratory distress, low Apgar score
45
How do you manage meconium aspiration?
Amnioinfusion (pumping sterile fluid into the amniotic sac to thin meconium) Extracorporeal membrane oxygen (ECMO) Surfactant Respiratory support
46
What causes persistent pulmonary hypertension of the newborn?
Failure to change from antenatal circulation to normal circulation resulting in pulmonary hypertension Which can lead to L to R shunting of blood
47
How do you manage persistent hypertension of the newborn?
Nitric oxide (pulmonary vasodilator) Oxygen IV prostaglandins
48
What is NEC?
Necrosis of bowel due to prematurity
49
What are the clinical features of NEC?
Abdominal distension Rectal bleeding Shock DIC
50
What kind of milk reduces risk of NEC?
Breast milk
51
How do you manage NEC?
Stop oral feeds, antibiotic over for bowel perforation, surgical opinion
52
What does ToRCH stand for?
``` Toxoplasmosis Other (HIV, chlamydia etc.) Rubella CMV HSV ```
53
What is TORCH syndrome?
Vertically transmitted infections
54
What clinical features can TORCH syndrome result in?
SFGA, fever, difficulty feeding, purpura, hepatosplenomegaly, jaundice, hearing impairment, autism/mental delay, specific abnormalities assoc with each cause
55
How common is Down's syndrome?
1 in 600 live births
56
What are the clinical features of Down's syndrome?
Round face, epicanthic folds, upslanted palpebral fissures, brushfield spots, flat nasal bridge, protruding tongue, small low set ears, flat occiput, third fontanelle, short neck, alanto-axial instability, hypotonia, single palmar crease, short stubby toes/fingers, saddle toe deformity, pelvic dysplasia
57
What conditions is Down's syndrome associated with?
``` Cataracts Epilepsy Early onset Alzheimer's Hypothyroidism CHD (ASVD) Duodenal atresia Hirschprungs Learning difficulties Leukaemia Hearing problems ```
58
What are allergies associated with?
Atopic diseases, e.g. asthma, hayfever, eczema
59
What are the clinical features of anaphylaxis?
Rash, throat swelling, angioedema, hypotension, airway obstruction, cyanosis, headaches, abdominal pain, anxiety
60
How do you manage acute anaphylaxis?
IM adrenaline, antihistamines, hydrocortisone | Intubation, nebulised adrenaline
61
What is the long term management of allergy?
Identification and avoidance of allergen EpiPen Allergy management plan for use in school/nursery
62
What are the clinical features of acute epiglottitis?
Acute onset high fever, looks toxic, drooling, muffled cough
63
What must you avoid doing in acute epiglottis?
Using tongue depressor can cause distress & airway obstruction
64
How do you manage acute epiglottitis?
Intubation/tracheostomy may be req. | Once stabilised needs blood cultures & IV antibiotics
65
What causes whooping cough?
Bordetella pertussis
66
What is the typical presentation with pertussis?
Characteristic episodic coughing episodes ending with a deep sharp inspiration May end in vomiting/fainting
67
What is the intubation period of pertussis?
7-10 days
68
How do you manage pertussis?
Vaccination | Antibiotics, e.g. erythromycin
69
What are potential complications of pertussis?
Pneumonia, encephalopathy, seizures
70
What commonly causes pneumonia?
H. influenzae (esp infants), pneumococcus, staph aureus, mycoplasma
71
What are the clinical features of pneumonia?
Fever, tachypnoea, feeding difficulties, cough, SoB
72
How do you manage community acquired pneumonia in children?
Admit if sats <92% Consider CXR/FBC/bloods if severe pneumonia Ix not req if sending child home <2y more likely to be viral LRTI & so send home wo antibiotics Amoxicillin 1st line (alt: co-amoxiclav, azithromycin, clarithromycin)

Paediatrics (35 decks)

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