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Y4 Paediatrics > Intro Week Lectures 1 > Flashcards

Intro Week Lectures 1 Flashcards

1
Q

How do you calculate a child’s bladder capacity?

A

Up to 12 yrs old
(Child’s Age + 1) x 30

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2
Q

What can cause a neuropathic bladder in kids?

A

spinal cord injury
brain injury / nerve damage
spina bifida
bladder extrophy - protrusion of bladder through defect in abdominal wall
cloacal malformation - ‘common channel’

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3
Q

What are the sxs of neuropathic bladder in kids?

A

UTI
Kidney stones
Urinary incontinence
Frequency + urgency
Small urine vol during voiding
Dribbling

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4
Q

How can a neuropathic bladder be managed?

A

intermittent catheterisation

suprapubic catheter

Mitrofanoff
- A tube created using the appendix or small intestine which connects the bladder to the surface of the skin

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5
Q

Give some structural urological problems that may be seen in kids

A

vesico-ureteric reflux - ureter goes straight through bladder wall instead of at an angle = retrograde flow of urine = severe / frequent UTIs

uterocele - distal ureter balloons at opening into bladder forming a sac - can cause obstruction

PUJ obstruction - (1/1500 children)

Posterior urethral valves (PUV) - extra membranes cause narrowing of urethra in boys, often spotted at antenatal USS

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6
Q

Give some signs and sxs of PUV

A

Delayed urination
Weak stream / difficulty urinating
Palpable bladder
Urosepsis
Lethargy and poor feeding
UTIs

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7
Q

How can PUV be investigated?

A

micturating cystourethrogram

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8
Q

Mx of PUV?

A

catheterisation
mx of any UTI / fluid imbalance
cystoscopy and valve ablation
regular assessment of kidney function, growth and bladder training

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9
Q

What can cause urinary incontinence in kids?

A

constipation
reduced drinking
neuropathic bladder
structural urological problems
holding / delaying access to toilet
ADHD / autism

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10
Q

OverActive Bladder (OAB) causes a frequent and sudden urge to urinate that may be difficult to control. It may present with incontinence in children.

What can cause it?

A

Constipation
Reduced drinking
Certain drinks - artificial juices, caffeine (bladder irritants)
Holding / delaying toileting
UTI’s

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11
Q

An underactive bladder is also known as detrusor underactivity which is a bladder that has a contraction reduced in strength or duration.

What sxs may this present with?

A

Prolonged time required to PU
Frequency / Urgency
Requiring to double void
Needing to wait for the flow to start

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12
Q

What can cause underactive bladder in kids?

A

Bladder outlet obstruction (PUV)
Neurological disorders
Spinal cord injuries

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13
Q

Sxs of UTI in kids?

A

Dysuria
Nocturia
Frequency/urgency
Abdominal pain
Fever
Cloudy/dark urine

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14
Q

Causes of UTI in kids?

A

Constipation
Dehydration
Withholding urine
Reflux
Increased bladder pressure

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15
Q

Give some causes of nocturnal enuresis in kids

A

Small bladder (inability to hold a large amount of urine)
No awareness of a full bladder
Ongoing Constipation
Stress at school or home
Poor daytime toilet habits

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16
Q

How can nocturnal enuresis be managed in kids if lifestyle modification does not work?

A

enuresis alarm
desmospressin

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17
Q

What ix can you do for a child with urological problems ?

A

Physical exam – abdominal palpation (bladder distention, Faecal loading)
Renal scans – USS +XRAY

Uroflowmetry
* Uroflow measures the vol of urine released from the body, the speed at which it is released and how long it takes to release

MAG3
* A MAG3 Renogram scan is used to assess the structure and location of the kidneys and to check how well they are working

DMSA
* Identifies the shape of the kidney and how well its functioning

Urodynamics
* Identifies how well the bladder can hold and release urine.

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18
Q

General lifestyle advice for children with urological problems?

A

Treating underlying constipation
Drinking plenty
Accessing the toilet every 2-3hrs
Sitting and relaxing the bladder
Avoid withholding/delaying

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19
Q

Define asthma

A

a disease that includes the symptoms of wheeze, cough and breathing difficulty together with reversible airways obstruction, airway inflammation and bronchial hyper-responsiveness.

It demonstrates variability

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20
Q

Define wheeze

A

Continuous musical (whistling) sound , usually expiratory

Due to oscillation of opposing airway walls that are narrowed
◦ Bronchospasm
◦ Swelling of mucosal lining
◦ Excessive secretions

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21
Q

Give some causes of wheeze in children

A

Asthma

Respiratory infections - often viral infections
* Bronchiolitis
* Bronchiolitis obliterans
* LRTI

Excess secretions
* CF
* Ciliary disease

Airway abnormalities
* Bronchomalacia
* Chronic lung disease of prematurity

Foreign body inhalation

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22
Q

What is spirometry?

A

Physiological test
– Records volume/flow of air over time

There are three distinct phases to the forced exhalation manoeuvre as follows:
1) maximal inspiration
2) a ‘‘blast’’ of exhalation
3) continued complete exhalation to the end of test

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23
Q

How do you carry out bronchodilator reversibility testing?

A

4 puffs of salbutamol (100mcg) via spacer/MDI
Repeat spirometry after 10-15 minutes

Increase in FEV1 of ≥12% is positive

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24
Q

How would you instruct a child on how to do a FeNo test?
What classes as a positive test?

A

Empty lungs
Close lips around mouthpiece
Inhale deeply until full
Exhale slowly (over 10 secs) through filter at constant pace “keep cloud within limits”

≥ 20ppb = positive test in kids

25
Q

What increases a child’s risk of an acute asthma attack?

A

Previous attacks
Over-reliance on SABA (relative to ICS)
Smoke exposure
Raised FeNO
Low FEV1

26
Q

Key steps in the mx of an acute asthma attack?

A

ABC
Oxygen to keep saturations 94% and above
SABA - inhaled – (5 puffs) or nebulised
Ipratropium bromide
Corticosteroids (oral, IV)
ICU if severe

27
Q

Questions to ask yourself to determine if a child has asthma?

A

Is there airway obstruction?
Is it variable?
Do they respond to asthma medication?

28
Q

How can you monitor how well controlled a child’s asthma is?

A
  • Asthma control tests
  • SABA use
  • Time off school
  • Exercise limitation
  • Daytime/nighttime symptoms
29
Q

What are the key side effects of asthma medications in kids?

A

Steroids
* Height, adrenal suppression

Montelukast
* Sleep disturbance, aggressive behaviour

30
Q

What plan should be made upon discharge for a child who has had an asthma attack?

A

Check inhaler technique
(Update) Personalised written asthma action plan
Ask family to make appointment with GP within 2 working days

31
Q

What is the long term mx of recurrent viral wheeze?

A

Encourage parents to stop smoking

IV treatment or ICU admission = treat
More than 4 hospital admissions/year or frequent need for oral CS = trial of treatment

SABA / anticholinergic via a spacer
intermittent LTRA, intermittent ICS

32
Q

Commonest cause of recurrent viral wheeze?

A

rhinovirus - type C

33
Q

What ix are useful for a child with suspected foreign body obstruction?

A

CXR: expiratory film - because obstructed lung cannot empty properly and will remain hyper inflated

if CXR unclear - have to do bronchoscopy

34
Q

Are corticosteroids helpful for pre-school wheeze?

A

not generally

35
Q

How can you manage rhinitis with post natal drip in kids?

A

steroid nasal spray and antihistamines

36
Q

Define neonate
Define infant

A

neonate - first 28 days of life
infant - first 12 months of life

37
Q

Common causes of vomiting after feeds?

A

reflux - GORD
CMP allergy - may also have rashes, problems with stool

38
Q

Causes of recurrent abdo pain with normal test results in kids?

A

constipation
RAPS- recurrent abdo pain syndrome (psychosomatic)
abdominal migraine

39
Q

What location of pain is suggestive of RAPS?

A

periumbilical - with tummy pain due to stress, kids tend to point at their belly button when asked where it is, a very localised pain that is not central makes a dx of RAPS less likely

40
Q

Define acute cough
What can cause this in kids?

A

recent onset of cough lasting < 3 weeks

Infection – viral, bacterial
non-infective – foreign body, irritant toxin

41
Q

Define subacute cough
What can cause it in kids?

A

also known as ‘prolonged acute cough’
3-8 weeks duration

Post viral cough – (can persist for 3 weeks following resolution)
Pertussis and similar infections
Children recovering from complicated pneumonia

42
Q

Define chronic cough
What can cause it in kids?

A

a cough lasting > 8 weeks

Persistent bacterial bronchitis (PBB) - dx of exclusion
Rhinitis and post-nasal drip
GORD
Recurrent aspiration - NM weakness
Bronchiectasis
Cystic fibrosis

43
Q

Define persistent / protracted bacterial bronchitis

A

1) Presence of wet cough (>4 weeks’ duration)

2) absence of symptoms or signs (i.e. specific cough pointers) suggestive of other causes

3) cough resolves following a 2–4 week course of an appropriate oral antibiotic i.e. co-amoxiclav

44
Q

Define bronchiectasis. How is it diagnosed?

A

Abnormal dilation and distortion of the bronchial tree

dx with High Resolution CT - signet ring sign

45
Q

What can cause bronchiectasis in kids?

A

Cystic fibrosis
Ciliary dyskinesia
Post infectious
Immunodeficiency
Aspiration

46
Q

Mx of bronchiectasis in kids?

A

Prophylactic Abx
Physiotherapy
Aggressive treatment of LRTI
Nutrition
Regular monitoring, inc. lung function

47
Q

Define recurrent cough

A

> 2 episodes of cough / year not associated with specific illness

48
Q

When should you consider CXR in a child with a cough?

A

suspicion of lower respiratory infection, persistent/non resolving cough, haemoptysis or features of chronic disorders

49
Q

Most common cause of CAP in children?

A

viral - RSV

50
Q

Mx of CAP in children?

A

Non-severe – oral antibiotics (amoxicillin) for 5 days
Severe – IV (amoxicillin or cefuroxime) antibiotics

51
Q

When would you consider pneumonia in a child to be ‘complicated’?

A

Parapneumonic effusion (pleural fluid collection in association with underlying pneumonia)- transudate/ exudate

Empyema (the presence of pus in the pleural space)

52
Q

How should you manage complicated pneumonia in a child?

A

Antibiotics (long course)

Chest drain + Intrapleural fibrinolytic agents (urokinase)

VATS (video assisted thoracoscopic surgery)

53
Q

What initial investigations might you do for a child with chronic wet cough?

A

Spirometry + Bronchodilator reversibility

Microbiology of respiratory tract – sputum/ induced sputum (if possible), swab

CXR

Sweat test, pancreatic function

Immune function testing – immunoglobulins, functional antibodies, allergy markers e.g. IgE and eosinophils

54
Q

Primary ciliary dyskinesia results in the lack of effective ciliary motility, causing abnormal mucociliary clearance. What clinical features does it present with?

A

Chronic wet cough
Sinusitis/ rhinitis, persistent nasal discharge
Situs inversus (40-50% - kartagener syndrome)

Associations- congenital heart lesions, asplenia, hydrocephalus, renal disease

55
Q

How is primary ciliary dyskinesia diagnosed?

A

Ciliary studies
Nasal nitric oxide

56
Q

How can sleep disordered breathing be investigated in kids?

A

Polysomnography (gold standard)
- Respiratory effort, nasal flow/pressure analysis, EEG for sleep staging

57
Q

What can cause obstructive sleep apnoea in kids?

A

Obesity
Adenotonsillitis, Allergic rhinitis,
Down syndrome, craniofacial syndromes, mps, neuromuscular disorders

58
Q

Complications of NIV in kids?

A

Pressure sore
Dry nose/mouth/conjunctivitis
Rhinitis
Increased flatulence (swallowing air)

59
Q

Complications of invasive ventilation in kids?

A

Loss of humidification system, thick secretions
Loss of natural defence, recurrent chest infection
Tracheostomy related effects e.g. granulations

Y4 Paediatrics (18 decks)

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