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Final FC Flashcards

1
Q

What are the three components of GCS, and what are they out of?

A

Eye opening: /4
Verbal: /5
Motor: /6

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2
Q

Explain the criteria for eye opening in GCS

A

4: spontaneous opening
3: open to voice
2: open to pain
1: NO opening

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3
Q

Explain the criteria for verbal response in GCS if >5yo

A

5: alerted to time and place
4: confused
3: inappropriate words
2: incomprehensible sounds
1: no response

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4
Q

Explain the criteria for verbal response in GCS if <5yo

A

5: ALERT, BABBLES, COOS AS NORMAL
4: less thna normal
3: cries to pain
2: moans to pain
1: no response

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5
Q

Explain criteria for motor response in CGS

A

6: obeys commands
5: localises to pain/ withdraws from touch
4: withdraws from pain
3: flexes to pain
2: extends to pain
1: NO response

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6
Q

What are criteria for mild / moderate / severe DKA

A

mild: pH >7.2
Mod: pH 7.2-7.1
Severe: pH <7.1

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7
Q

What are the correct times for performing CVS vs amniocentesis

A

Chorionic villus sampling: 11-14 weeks

amniocentesis: 15+

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8
Q

what is first line management for absence seizures

A

ethosuximide

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9
Q

what causes a reflex anoxic seizure

A

Sudden unexpected fright /pain

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10
Q

what causes a breath holding spell

A

vigorous crying / sobbing

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11
Q

Explain pre-during-after of reflex anoxic seizure

A

Pre: sudden unexpected fright or pain
During: cyanotic/grey colour, LOC, limp/stiff, clonus, twitch, lasts few mins, regain conscioussnes
After: gradual

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12
Q

Explain pre-during-after of breath holding spell

A

Pre: vigorous crying and sobbing
During: child becomes silent, holds breath on exhaltionl, cyanotic, brief LOC
After: regain consciusness after less than a min

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13
Q

what are the age appropriate doses of adrenaline in anaphylaxis

A

<6yo: 150 mcg of 1:1000

6-12yo: 300 mcg

12+: 500 mcg

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14
Q

What is early approach (before adrenaline) approach to anaphylaxis

A 
Remove trigger if possible
Call for help early
Lie patient flat and raise legs
ABCDE assessment
Administer adrenaline
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15
Q

what is management of anaphylaxis once skills and equipment bvecome available

A

Establish airway
High flow oxygen
IV fluid challenge
Administer chlorphenamine and hydrocortisone
Attach patient to monitoring (pulse oximetry, ECG, BP)

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16
Q

What are indications for referring children with possible seizure

A

Refer URGENTLY ALL children suspected of having a first epileptic seizure to NEUROLOGIST

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17
Q

What advice do you give to child presenting with possible seizure

A
  • advise parent / carer how to recognise seizure
  • Record all future episodes by video
  • Avoid dangerous activities until diagnosis is confirmed
  • Seek help if another seizure occurs before referral
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18
Q

What antiepileptic is preferred to valproate in young girl of childbearing ager

A

lamotrigine

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19
Q

What precautions must you take for child with epilepsy for sports?

A

Avoid situations where having a seizure could lead to death:

  • bicycle: wear helmet and avoid busy roads
  • swimming: observed 1:1
  • climbing: helmet and harness up wall
  • driving: not allowed until no seizures for up to one year
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20
Q

What are risks of not taking epilepsy medication?

A
  • trauma during tonic clonic seizure
  • hypoxic brain injury if prolonged
  • seizures may become progressively worse, leading to status epiletticus
  • SUDEP (Sudden Unexpected Death in Epilepsy) - 1:1000 die, more common if poorly controlled seizures
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21
Q

What TRIAD occurs with West Syndrome

A
  • infantile spasm
  • developmental delay
  • Hypsarrythmia on EEG
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22
Q

Describe an infantile spasm

A

flexion of waist, trunk and arms > extension of arms
very brief, only lasts few seconds
occur in clusters

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23
Q

What are the red flags for a brain tumour as indicated by the HEADSMART guidelines?

A
  • Headache - persistent, most days, wakes up child, child disoriented
  • Vomiting - persistent, wakes up child, with headache, without nausea/vomiting
  • Eyes - abnormal movement, vision blurred/lost (moves head to compensate / clingy in unknown surroundings)
  • Loss of balance/coordination (regression in previously aquired skills)
  • Behaviour change - tired, lack of enthusiasm
  • Neck - still, head tilted, wry neck
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24
Q

what is the most common form of epilepsy in children

A

Benign Rolandic Epilepsy

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25
What age range does Benign Rolandic Epilepsy occur
8 years old to 14-18 years old
26
What are the FOUR key sx of Benign Rolandic Epilepsy
benign focal epilepsy, consciousness in maintained - Unilateral facial sensorimotor symptoms (sudden contraction of half of mouth/face) - Oropharyngeal ictus (paraesthesia inside mouth, strange sounds) - Arrest of speech (mouth opens but cannot speak) - Hypersalivation (mouth full of saliva)
27
How do you manage Benign Rolandic Epilepsy
mostly conservative, will self resolve
28
what are 2 resources for epilepsy
Epilepsy action | Epilepsy society Uk
29
What ix confirms malrotatio
Upper GI contrast study
30
How can you treat Wilsons disease
Penicillamine
31
Explain NICE guidelines for traumatic head injury
- Loss of consciousness >5mins - Abnormal drowsiness - Vomiting x3 or more - Dangerous mechanism of injury - Amnesia > 5mins - On warfarin if 0-1: observe for 4h if 2+: urgent CT Immediate CT and trauma call if: - GCS<15 - suspected open/depressed skull fracture - seizure - focal neuro deficit
32
What is Waterhouse-Friderichsen syndrome.
Meningococcal meningitis + septicaemia + ADRENAL HAEMORRHAGE + SHOCK
33
what score can you use for croup?
Westley Croup Score
34
What is the appropriate treatment for duodenal aatresia?
Duodenoduodenostomy
35
Long term complications of sickle cell anaemia
short stature, delayed puberty Stroke, cognitive impairment, neuro damage adenotonsillar hypertrophy (OSA) cardiac enlargement - from chronic anaemia heart failure - from uncorrected anaemia pigment gallstones PSYCHOSOCIAL PROBLEMS - due top time off school
36
What prophylaxis can you give for sickle celll
- immunise against encapsulated organisms - daily oral penicillin - daily oral folic acid - avoid triggers from vaso occlusive crises
37
How do you treat an acute crisis in sickle cell
``` Analgesia Good hydration Infection with antibiotics Oxygen Exchange itranfusion for Acute Chest Syndrome, priaprism, stroke ```
38
what is the sign for acute appendicitis called, and what does it mean
Rosving's sign Upon releasing pressure from palpation of the LIF, patient will feel pain on the RIF
39
How would you measure fever in a child?
Temp dot in axilla if <4wks | Tympanic membrane if >4wks
40
What are features of simple vs complex febrile convulsions?
Simple: - less than 15 min duration - tonic clonic - resolve spontaneously - do not recur within 24h - milf post ictal phase, complete recovery within 1h Complex: - >15 mins - focal at onset - recurrence within 24 h or in same febrile illness - prolonged ictal fase
41
when would you get EEG vs MRI for seizures?
if generalised: only MRI | if focal: MRI+ EEG
42
Limit ages for gross motor
Sit unsupported: 9m Stand: 12m Walk: 18m
43
LImit ages for vision and fine motore
Transfer objects between hands 9m | Pincer grip 12m
44
Social and behaviour limit ages
smile: 10 weeks | spoon to mouth: 18m
45
Hearing and speech limit ages
First word: 12 months 6 words: 18 months 3 word sentences: 3 years
46
How do you manage acute migraine
Nasal triptan + NSAID /paracetamol
47
How do you manage prophylaxis for migraines
Propanolol + topiremate (carbonic anhydrase inhibitor)
48
What guidelines can you use for classifying headaches
International headache society criteria
49
Complications of meningococcal septicaemia
``` Hearing loss Learning problems Epilepsy (due to brain injury) Kidney problems Joint/bine probkems (scarring in tissue) ```
50
WHat age children do you treat for bedwetting
OVER 5 YEARS OLD ONLY
51
What is management for bedwetting
1. Star chart/reward system - for agreed behaviour (don't drink before bed, go toilet) NOT for dry nights 2. Bell and pad alarm >7yo 3. SHort term relief: desmopressin 4. Refer to paeds specialist: ipiramine /oxybutinin
52
What dose lorazepam do you give in an epileptic child
0.1mg/kg IV up to 4kg
53
What do anaesthetists do if no response to all the antiepileptic meds you can give during tonic clonic seizure
Rapid sequence induction using thiopentone, intubation and ventilation Transfer to ICU
54
What outlook advice can you give for epilepsy
Outlook is better than people imagine - 5 in 10 people have no seizures at all over 5 year period - 3 in 10 will have some seizures, but fewer than if they didnt take meds - in total, 8 in 10 are wekll controlled with either no or few seizures
55
What are the dose of buccal midazolam/ rectal diazepam given in seizures
0.5mg/kg
56
what children are at high risk of DKA
- peripubertal/adolescent girls - difficult home life - eating disorders - limited access to health service
57
What can the duration of an anaphylactic reaction be?
You can have a BIPHASIC reaction With second reaction occurring 4-6 hours after the initial one so all patients need to be monitored in hospital up to 6 hours after their initial reaction
58
What can you measure to confirm anaphylaxis reaction during the episode
Mast cell tryptase
59
what does RDS look like on CXR
Ground glass opacity | remember - it occurs from lack of surfactant
60
How do you manage RDS?
intratracheal artificial surfactant
61
explain what a splenic seq crisis is like i'm a two year old
sickle cells blood the blood vessels leading out of the spleen this traps bloods in the spleen (splenic pooling of blood) This causes acute splenomegaly + pallor, fatigue
62
Explain blood count in splenic crisis
low Hb, low reticulocytes | Howell Jolly bodies
63
another name for the mantoux test
Tuberculin skin test
64
What ranges on mantoux test indicate TB
>15 : always TB 10-15: TB if high risk >5 if HIV positive or recent contact with active TB
65
How do you give fluids in children if you cannot get an IV access?
IO
66
What is the FIRST test to do in a child with language delay?
Hearing test (evoked audiometry)
67
What are common complication of chicken pox in children
Secondary skin infection (by strep/staph)
68
Investigations for precocious puberty:
FIRST LINE: - bone age assessment (left hand X ray) - LH, FSH (helps distinguish gonadotrophin indep vs dep) - serum testosterone, oestrongen (helps confirm onset of puberty) - USS pelvis (exclude oestrogen secreting ovarian tumour) - LHRH stim test (Gonadotroph indep vs indep) SECOND LINE: MRI brain etc
69
What criteria other than CENTOR can you use when deciding if you should give Abx to tonsillitis? + explain
FeverPAIN - Fever (during previous 24 hours) - Purulence (pus on tonsils) - Attend rapidly (within 3 days after onset of symptoms) - Inflamed tonsils - No cough or coryza (inflammation of mucus membranes in the nose) Each of the FeverPAIN criteria score 1 point (maximum score of 5). Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause. A score of 4/5 = 60% likelihood of isolating streptococcus.
70
when should you recheck bilirubin in a baby with bilirubin that is <50mmol below threshold line?
recheck within 18 hours
71
How does aortic stenosis present on ascultatyion
Ejection systolic murmur at the RIGHT UPPER sternal edge.
72
How does ASD present on ascultation
Ejection systolic on LEFT upper sternal edge
73
How does osteosarcoma present differently to Ewing's sarcoma
Osteosarcoma: most common, affects distal femur/proximal tibia Ewing: presents similarly to infection with fever. most likely affects DIAPHYSIS (SHAFT)\
74
what maternal disease is Tranposition of the Great Arteries associated with
maternal diabetes
75
How can you estimate the. weight in kg for a child 1-5 yo?
2x age + 8
76
what is a positive prehn's test and what does it indicate
relief of pain upon elevation of the testicle | indicates epidydimitis
77
What does a peritonsillaar abscess look like
unilateral tonsillar swelling + pus ON JUST ONE TONSIL
78
what do you do if baby is DDH + on NIPE?
review in clinic with USS in 2 weeks!
79
Viral causes of gastroenteritis & features
Rotavirus - 5-7 days, vomiting+ diarrhoea + fever Norovirus 1-3 days, vomiting (>diarrhoea) Adenovirus: mild vomiting > diarrhoea 2 weekz
80
RDS on CXR
ground glass
81
TTN on CXR
interstitial lines, small effusions pulmonary oedema in the neonate usually associated with caesarian section delivery
82
meconium aspiration on CXR
IN TERM/POSTDATES - bilateral PATCHY airspace shadowing - large volume lungs - small pleural effusions
83
What does broncopulmonary dysplasia look like on CXR
areas of opacification | cystic changes
84
what infectious disease is spreading in north london
measles

Y5 Paediatrics (30 decks)

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