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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
Q

What is the symmetrical tonic neck reflex?

A

Flex baby’s head forward and arms/legs should extend (opposite when baby’s head is extended)

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26
Q

What is the doll’s eye reflex?

A

When baby’s head manually turned, eyes will stay fixed instead of moving with the head

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27
Q

What is the Gurthrie test?

A

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

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28
Q

Define prematurity

A

<37 weeks gestation

Extreme prematurity <28 weeks

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29
Q

What complications are premature babies at risk of?

A

RDS, sepsis, IVH, PDA, NEC, RoP

30
Q

Define low birth weight

31
Q

Define v. low birth weight

32
Q

Define extremely low birth weight

33
Q

What causes low birth weight

A

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
Q

What is HIE?

A

Neonatal brain injury secondary to hypoxia

35
Q

What are the clinical findings of HIE?

A

CNS (mild HIE - hyperalert, hypotonia, severe HIE –stuporose/comatose, seizures), Other organ damage including kidney, cardiovascular and haematological disturbances

36
Q

How do you diagnose HIE?

A

EEG shoes marked voltage suppression or isoelectric (flat)

37
Q

How do you manage HIE?

A

Cooling, supportive Rx

38
Q

What is the prognosis of HIE?

A

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
Q

Define hypoglycaemia in the newborn

40
Q

What are the aetiologies of neonatal hypoglycaemia?

A 
Normal (glucose drops in first few hrs of life) 
Gestational diabetes
Prematurity 
Hypothermia
Infection
Breathing difficulties at birth
41
Q

What are the clinical features of neonatal hypoglycaemia?

A

Irritability, sleepiness, floppiness, seizures, apnoea, hunger, vomiting

42
Q

How do you manage neonatal hypoglycaemia?

A

Breast feeding/expressed milk or formula milk, maintain skin to skin contact (encourages feeds), NG/IV dextrose/glucagon/octreotide

43
Q

What is meconium aspiration syndrome?

A

Pneumonitis due to aspiration of meconium before or during delivery (often due to foetal distress/hypoxia)

44
Q

What are the clinical features of meconium aspiration syndrome?

A

Green/yellow amniotic fluid, meconium staining of neonate (skin, nails etc.), respiratory distress, low Apgar score

45
Q

How do you manage meconium aspiration?

A

Amnioinfusion (pumping sterile fluid into the amniotic sac to thin meconium)
Extracorporeal membrane oxygen (ECMO)
Surfactant
Respiratory support

46
Q

What causes persistent pulmonary hypertension of the newborn?

A

Failure to change from antenatal circulation to normal circulation resulting in pulmonary hypertension

Which can lead to L to R shunting of blood

47
Q

How do you manage persistent hypertension of the newborn?

A

Nitric oxide (pulmonary vasodilator)
Oxygen
IV prostaglandins

48
Q

What is NEC?

A

Necrosis of bowel due to prematurity

49
Q

What are the clinical features of NEC?

A

Abdominal distension
Rectal bleeding
Shock
DIC

50
Q

What kind of milk reduces risk of NEC?

A

Breast milk

51
Q

How do you manage NEC?

A

Stop oral feeds, antibiotic over for bowel perforation, surgical opinion

52
Q

What does ToRCH stand for?

A 
Toxoplasmosis
Other (HIV, chlamydia etc.)
Rubella
CMV
HSV
53
Q

What is TORCH syndrome?

A

Vertically transmitted infections

54
Q

What clinical features can TORCH syndrome result in?

A

SFGA, fever, difficulty feeding, purpura, hepatosplenomegaly, jaundice, hearing impairment, autism/mental delay, specific abnormalities assoc with each cause

55
Q

How common is Down’s syndrome?

A

1 in 600 live births

56
Q

What are the clinical features of Down’s syndrome?

A

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
Q

What conditions is Down’s syndrome associated with?

A 
Cataracts
Epilepsy
Early onset Alzheimer's
Hypothyroidism
CHD (ASVD)
Duodenal atresia
Hirschprungs
Learning difficulties
Leukaemia
Hearing problems
58
Q

What are allergies associated with?

A

Atopic diseases, e.g. asthma, hayfever, eczema

59
Q

What are the clinical features of anaphylaxis?

A

Rash, throat swelling, angioedema, hypotension, airway obstruction, cyanosis, headaches, abdominal pain, anxiety

60
Q

How do you manage acute anaphylaxis?

A

IM adrenaline, antihistamines, hydrocortisone

Intubation, nebulised adrenaline

61
Q

What is the long term management of allergy?

A

Identification and avoidance of allergen
EpiPen
Allergy management plan for use in school/nursery

62
Q

What are the clinical features of acute epiglottitis?

A

Acute onset high fever, looks toxic, drooling, muffled cough

63
Q

What must you avoid doing in acute epiglottis?

A

Using tongue depressor can cause distress & airway obstruction

64
Q

How do you manage acute epiglottitis?

A

Intubation/tracheostomy may be req.

Once stabilised needs blood cultures & IV antibiotics

65
Q

What causes whooping cough?

A

Bordetella pertussis

66
Q

What is the typical presentation with pertussis?

A

Characteristic episodic coughing episodes ending with a deep sharp inspiration
May end in vomiting/fainting

67
Q

What is the intubation period of pertussis?

68
Q

How do you manage pertussis?

A

Vaccination

Antibiotics, e.g. erythromycin

69
Q

What are potential complications of pertussis?

A

Pneumonia, encephalopathy, seizures

70
Q

What commonly causes pneumonia?

A

H. influenzae (esp infants), pneumococcus, staph aureus, mycoplasma

71
Q

What are the clinical features of pneumonia?

A

Fever, tachypnoea, feeding difficulties, cough, SoB

72
Q

How do you manage community acquired pneumonia in children?

A

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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